Provider Demographics
NPI:1124142013
Name:THERAPY MEDICAL-WELLNESS CENTERS, LLC
Entity type:Organization
Organization Name:THERAPY MEDICAL-WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER - CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALOYSIUS
Authorized Official - Middle Name:K
Authorized Official - Last Name:KWAKUMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-755-5278
Mailing Address - Street 1:368 W PIKE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3240
Mailing Address - Country:US
Mailing Address - Phone:770-755-5278
Mailing Address - Fax:770-755-5682
Practice Address - Street 1:368 W PIKE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3240
Practice Address - Country:US
Practice Address - Phone:770-755-5278
Practice Address - Fax:770-755-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005865261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy