Provider Demographics
NPI:1508682063
Name:ERGONZO LLC
Entity type:Organization
Organization Name:ERGONZO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:917-497-7172
Mailing Address - Street 1:1345 SEABOARD INDUSTRIAL BLVD NW # S5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2824
Mailing Address - Country:US
Mailing Address - Phone:404-445-3469
Mailing Address - Fax:
Practice Address - Street 1:1345 SEABOARD INDUSTRIAL BLVD NW # S5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2824
Practice Address - Country:US
Practice Address - Phone:404-445-3469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy