Provider Demographics
NPI:1902281017
Name:MODI, PRIYANKA M (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:M
Last Name:MODI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:1600 MEDICAL WAY
Mailing Address - Street 2:150
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2166
Mailing Address - Country:US
Mailing Address - Phone:770-978-5326
Mailing Address - Fax:770-979-7312
Practice Address - Street 1:1600 MEDICAL WAY
Practice Address - Street 2:150
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2166
Practice Address - Country:US
Practice Address - Phone:770-978-5326
Practice Address - Fax:770-979-7312
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0119242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic