Provider Demographics
NPI:1063766780
Name:ONCORE PT, INC
Entity type:Organization
Organization Name:ONCORE PT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-393-0111
Mailing Address - Street 1:4505 ASHFORD DUNWOODY RD NE STE 13
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1516
Mailing Address - Country:US
Mailing Address - Phone:770-393-0111
Mailing Address - Fax:770-393-0109
Practice Address - Street 1:1305 HEMBREE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3810
Practice Address - Country:US
Practice Address - Phone:770-393-0111
Practice Address - Fax:770-393-0109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONCORE PT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7707Medicare UPIN