Provider Demographics
NPI:1790035475
Name:AAPOLLO STROKE CENTER, INC.
Entity type:Organization
Organization Name:AAPOLLO STROKE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:APOLLONE
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPH, ABD
Authorized Official - Phone:404-518-8206
Mailing Address - Street 1:752 KEY LARGO POINTE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-2287
Mailing Address - Country:US
Mailing Address - Phone:404-518-8206
Mailing Address - Fax:770-277-1357
Practice Address - Street 1:752 KEY LARGO POINTE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-2287
Practice Address - Country:US
Practice Address - Phone:404-518-8206
Practice Address - Fax:770-277-1357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA765677599AMedicaid
GA765677599AMedicaid