Provider Demographics
NPI:1336196948
Name:FREEMYER, BRAD STEPHEN (PT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:STEPHEN
Last Name:FREEMYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:930 WOODSTOCK RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2220
Mailing Address - Country:US
Mailing Address - Phone:770-998-6636
Mailing Address - Fax:770-998-6646
Practice Address - Street 1:930 WOODSTOCK RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2220
Practice Address - Country:US
Practice Address - Phone:770-998-6636
Practice Address - Fax:770-998-6646
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0026612251G0304X, 2251S0007X, 2251X0800X
GAPT0002661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCKSMedicare ID - Type UnspecifiedMEDICARE PROVIDER #