Provider Demographics
NPI:1093554891
Name:ICARE HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:ICARE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAO
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-381-8240
Mailing Address - Street 1:183 DOVER COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8469
Mailing Address - Country:US
Mailing Address - Phone:770-381-8240
Mailing Address - Fax:
Practice Address - Street 1:1200 ALTMORE AVE STE C-200
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-2449
Practice Address - Country:US
Practice Address - Phone:404-751-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty