Provider Demographics
NPI:1881274173
Name:ESSENTIAL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ESSENTIAL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:910-818-3262
Mailing Address - Street 1:1099 BOULEVARD SE APT 2201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3876
Mailing Address - Country:US
Mailing Address - Phone:910-818-3262
Mailing Address - Fax:
Practice Address - Street 1:1099 BOULEVARD SE APT 2201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3876
Practice Address - Country:US
Practice Address - Phone:910-818-3262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty