Provider Demographics
NPI:1962529420
Name:BIVEN, THERESA M (PT, CWS)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:BIVEN
Suffix:
Gender:F
Credentials:PT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2369 HOWELL MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1625
Mailing Address - Country:US
Mailing Address - Phone:404-605-0829
Mailing Address - Fax:
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:35 BUILDING LOBBY LEVEL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-2743
Practice Address - Fax:404-609-6659
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist