Provider Demographics
NPI:1134538606
Name:ABILITY PEDIATRIC THERAPY
Entity type:Organization
Organization Name:ABILITY PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:P
Authorized Official - Phone:770-891-1362
Mailing Address - Street 1:2741 QUILLIANS DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2885
Mailing Address - Country:US
Mailing Address - Phone:770-891-1362
Mailing Address - Fax:
Practice Address - Street 1:2741 QUILLIANS DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-2885
Practice Address - Country:US
Practice Address - Phone:770-891-1362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000812149EMedicaid