Provider Demographics
NPI:1194887315
Name:THERASPORT PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:THERASPORT PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF FINACIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:678-584-1622
Mailing Address - Street 1:PO BOX 923387
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-3387
Mailing Address - Country:US
Mailing Address - Phone:678-584-1622
Mailing Address - Fax:678-584-1673
Practice Address - Street 1:10160 MEDLOCK BRIDGE RD
Practice Address - Street 2:STE B
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4419
Practice Address - Country:US
Practice Address - Phone:678-584-1622
Practice Address - Fax:678-584-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7320Medicare ID - Type Unspecified