Provider Demographics
NPI:1184105405
Name:PURE REHAB PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PURE REHAB PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARTHING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:678-685-7270
Mailing Address - Street 1:840 KENNESAW AVE NW STE 2
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7928
Mailing Address - Country:US
Mailing Address - Phone:678-685-7270
Mailing Address - Fax:678-503-2807
Practice Address - Street 1:840 KENNESAW AVE NW STE 2
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7928
Practice Address - Country:US
Practice Address - Phone:678-685-7270
Practice Address - Fax:678-503-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00076578261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy