Provider Demographics
NPI:1336238245
Name:PROCARE THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:PROCARE THERAPY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANKAR
Authorized Official - Middle Name:NARAYAN
Authorized Official - Last Name:VISWANATHA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:229-392-3663
Mailing Address - Street 1:607 42ND ST E
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1549
Mailing Address - Country:US
Mailing Address - Phone:229-392-3663
Mailing Address - Fax:229-387-0568
Practice Address - Street 1:607 42ND ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1549
Practice Address - Country:US
Practice Address - Phone:229-392-3663
Practice Address - Fax:229-387-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty