Provider Demographics
NPI:1457124299
Name:PRELL INTEGRATIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PRELL INTEGRATIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-936-0273
Mailing Address - Street 1:2230 HARPERFIELD TER
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2512
Mailing Address - Country:US
Mailing Address - Phone:678-936-0273
Mailing Address - Fax:
Practice Address - Street 1:2230 HARPERFIELD TER
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2512
Practice Address - Country:US
Practice Address - Phone:678-936-0273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty