Provider Demographics
NPI:1952920696
Name:MICHELE POND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MICHELE POND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:POND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-551-1207
Mailing Address - Street 1:4429 DUNMORE RD NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4224
Mailing Address - Country:US
Mailing Address - Phone:773-551-1207
Mailing Address - Fax:
Practice Address - Street 1:910 MARIETTA HWY STE 240
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6750
Practice Address - Country:US
Practice Address - Phone:773-551-1207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy