Provider Demographics
NPI:1528489853
Name:REFORM PHYSICAL THERAPY
Entity type:Organization
Organization Name:REFORM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER - PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-445-7942
Mailing Address - Street 1:1705 MOUNT VERNON RD STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4257
Mailing Address - Country:US
Mailing Address - Phone:404-445-7942
Mailing Address - Fax:
Practice Address - Street 1:1705 MOUNT VERNON RD STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4257
Practice Address - Country:US
Practice Address - Phone:404-445-7942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7689261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy