Provider Demographics
NPI:1306462825
Name:GOTHEREX USA, LLC
Entity type:Organization
Organization Name:GOTHEREX USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:REUSCHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:770-324-3726
Mailing Address - Street 1:2700 BRASELTON HWY STE 10-405
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3262
Mailing Address - Country:US
Mailing Address - Phone:770-324-3726
Mailing Address - Fax:
Practice Address - Street 1:2411 LANCE RIDGE WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7999
Practice Address - Country:US
Practice Address - Phone:770-324-3726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty