Provider Demographics
NPI:1124174487
Name:PEARL, MACIA J (PT)
Entity type:Individual
Prefix:DR
First Name:MACIA
Middle Name:J
Last Name:PEARL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6216 MEADOW RUN CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4622
Mailing Address - Country:US
Mailing Address - Phone:770-453-9366
Mailing Address - Fax:
Practice Address - Street 1:11180 STATE BRIDGE RD
Practice Address - Street 2:SUITE 503
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7482
Practice Address - Country:US
Practice Address - Phone:770-360-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist