Provider Demographics
NPI:1649280801
Name:TOVIN, BRIAN JEFFREY (DPT, SCS, ATC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JEFFREY
Last Name:TOVIN
Suffix:
Gender:M
Credentials:DPT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 OSBORNE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2831
Mailing Address - Country:US
Mailing Address - Phone:404-477-7777
Mailing Address - Fax:404-477-7000
Practice Address - Street 1:2669 OSBORNE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-2831
Practice Address - Country:US
Practice Address - Phone:404-477-7777
Practice Address - Fax:404-477-7000
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P43769Medicare UPIN
GA65BBBPXMedicare ID - Type Unspecified