Provider Demographics
NPI:1316456627
Name:ATHLETIC DEVELOPMENT AND PERFORMANCE THERAPY
Entity type:Organization
Organization Name:ATHLETIC DEVELOPMENT AND PERFORMANCE THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:404-400-6242
Mailing Address - Street 1:5616 PEACHTREE RD STE 180
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2312
Mailing Address - Country:US
Mailing Address - Phone:404-400-6242
Mailing Address - Fax:404-332-0308
Practice Address - Street 1:5616 PEACHTREE RD STE 180
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2312
Practice Address - Country:US
Practice Address - Phone:404-400-6242
Practice Address - Fax:404-332-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty