Provider Demographics
NPI:1588167266
Name:OZOH, JOHN LARRY (DPT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LARRY
Last Name:OZOH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 WESTBURY CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3178
Mailing Address - Country:US
Mailing Address - Phone:678-499-2172
Mailing Address - Fax:770-910-9792
Practice Address - Street 1:201 EVERGREEN TER
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7375
Practice Address - Country:US
Practice Address - Phone:770-288-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist