Provider Demographics
NPI:1356419493
Name:COMPREHENSIVE THERAPY SOLUTIONS
Entity type:Organization
Organization Name:COMPREHENSIVE THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,OTR,CHT
Authorized Official - Phone:678-992-0303
Mailing Address - Street 1:11180 STATE BRIDGE RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7482
Mailing Address - Country:US
Mailing Address - Phone:678-992-0303
Mailing Address - Fax:678-992-0302
Practice Address - Street 1:11180 STATE BRIDGE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7482
Practice Address - Country:US
Practice Address - Phone:678-992-0303
Practice Address - Fax:678-992-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006067225100000X
OT000932225X00000X
GAOTOOO932225XH1200X
GAPT006934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA501099970BMedicaid
GAGRP6203Medicare PIN
GA501099970BMedicaid