Provider Demographics
NPI:1992999510
Name:ELSBERRY, ROBERT KENT
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KENT
Last Name:ELSBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 TOWNE LAKE PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:678-445-9799
Mailing Address - Fax:678-445-2688
Practice Address - Street 1:1432 TOWNE LAKE PKWY
Practice Address - Street 2:STE 120
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:678-445-9799
Practice Address - Fax:678-445-2688
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist