Provider Demographics
NPI:1669529905
Name:NORTH FULTON PHYSICAL THERAPY AND SPORTS MEDICINE, INC.
Entity type:Organization
Organization Name:NORTH FULTON PHYSICAL THERAPY AND SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:770-442-0727
Mailing Address - Street 1:1750 FOUNDERS PKWY STE 126
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7600
Mailing Address - Country:US
Mailing Address - Phone:770-442-0727
Mailing Address - Fax:770-343-9607
Practice Address - Street 1:1750 FOUNDERS PKWY STE 126
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7600
Practice Address - Country:US
Practice Address - Phone:770-442-0727
Practice Address - Fax:770-343-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11-6603Medicare ID - Type UnspecifiedCERTIFIED REHAB. PROVIDER