Provider Demographics
NPI:1912700576
Name:MANGIARELLI REHABILITATION OF GEORGIA LLC
Entity type:Organization
Organization Name:MANGIARELLI REHABILITATION OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MANGIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:330-984-7799
Mailing Address - Street 1:2700 BRASELTON HWY STE 10-206
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 BRASELTON HWY STE 10-206
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3262
Practice Address - Country:US
Practice Address - Phone:330-984-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANGIARELLI REHABILITATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-29
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy