Provider Demographics
NPI:1588124879
Name:BIRDS OF PARADISE PHYSICAL THERAPY SERVICES,LLC
Entity type:Organization
Organization Name:BIRDS OF PARADISE PHYSICAL THERAPY SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYA
Authorized Official - Middle Name:CHARISE
Authorized Official - Last Name:TAMPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:678-651-4902
Mailing Address - Street 1:754 POST ROAD LN
Mailing Address - Street 2:ADDRESS LINE 2
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088
Mailing Address - Country:US
Mailing Address - Phone:678-651-4902
Mailing Address - Fax:
Practice Address - Street 1:913 MAIN ST STE I
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3096
Practice Address - Country:US
Practice Address - Phone:678-694-8100
Practice Address - Fax:678-647-7939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty