Provider Demographics
NPI:1699905554
Name:SANDY SPRINGS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SANDY SPRINGS PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-477-5555
Mailing Address - Street 1:5290 ROSWELL RD
Mailing Address - Street 2:STE #W
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1978
Mailing Address - Country:US
Mailing Address - Phone:404-477-5555
Mailing Address - Fax:404-477-5556
Practice Address - Street 1:5290 ROSWELL RD
Practice Address - Street 2:SUITE W
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1978
Practice Address - Country:US
Practice Address - Phone:404-477-5555
Practice Address - Fax:404-477-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty