Provider Demographics
NPI:1134749336
Name:SIMPLICITY THERAPY GROUP INC
Entity type:Organization
Organization Name:SIMPLICITY THERAPY GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-314-9295
Mailing Address - Street 1:PO BOX 1901
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-1901
Mailing Address - Country:US
Mailing Address - Phone:678-314-9295
Mailing Address - Fax:
Practice Address - Street 1:115 ACADEMY ST STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3008
Practice Address - Country:US
Practice Address - Phone:404-444-1521
Practice Address - Fax:404-689-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003204647CMedicaid