Provider Demographics
NPI:1962460451
Name:FOUNDATION THERAPY CENTER - NORTH ATLANTA, LLC
Entity Type:Organization
Organization Name:FOUNDATION THERAPY CENTER - NORTH ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-435-5052
Mailing Address - Street 1:6160 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE B90
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:770-673-0093
Mailing Address - Fax:770-673-8368
Practice Address - Street 1:6160 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE B90
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-673-0093
Practice Address - Fax:770-673-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
GAGRP6025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6025Medicare PIN