Provider Demographics
NPI:1912949322
Name:IMMANUELS WORD INC
Entity Type:Organization
Organization Name:IMMANUELS WORD INC
Other - Org Name:BODY PROS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-624-9117
Mailing Address - Street 1:1750 FOUNDERS PARKWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7602
Mailing Address - Country:US
Mailing Address - Phone:678-624-9117
Mailing Address - Fax:678-624-0747
Practice Address - Street 1:1750 FOUNDERS PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-7602
Practice Address - Country:US
Practice Address - Phone:678-624-9117
Practice Address - Fax:678-624-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7094Medicare PIN