Provider Demographics
NPI:1134587074
Name:FUNCTIONIZE HEALTH & PHYSICAL THERAPY
Entity type:Organization
Organization Name:FUNCTIONIZE HEALTH & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:678-637-1497
Mailing Address - Street 1:1199 SAINT ANDREWS CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3201
Mailing Address - Country:US
Mailing Address - Phone:678-637-1497
Mailing Address - Fax:678-587-5524
Practice Address - Street 1:1199 SAINT ANDREWS CIR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-3201
Practice Address - Country:US
Practice Address - Phone:678-637-1497
Practice Address - Fax:678-587-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006885261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy