Provider Demographics
NPI:1932571189
Name:BRENAU REHABILITATION PRACTICE GAINESVILLEPHYSICAL THERAPY
Entity Type:Organization
Organization Name:BRENAU REHABILITATION PRACTICE GAINESVILLEPHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-297-1700
Mailing Address - Street 1:1296 SIMS STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3850
Mailing Address - Country:US
Mailing Address - Phone:770-297-1700
Mailing Address - Fax:770-297-1702
Practice Address - Street 1:301 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3777
Practice Address - Country:US
Practice Address - Phone:770-297-1700
Practice Address - Fax:770-297-1702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAINESVILLE PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty