Provider Demographics
NPI:1205342730
Name:TOTAL HEALTH PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:TOTAL HEALTH PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:CHERUKARA
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-634-4918
Mailing Address - Street 1:115 GRANVILLE CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3432
Mailing Address - Country:US
Mailing Address - Phone:770-634-4918
Mailing Address - Fax:
Practice Address - Street 1:4355 GEORGETOWN SQ
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6266
Practice Address - Country:US
Practice Address - Phone:770-285-8908
Practice Address - Fax:770-986-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty