Provider Demographics
NPI:1356785752
Name:ALLSTAR PHYSICAL THERAPY
Entity type:Organization
Organization Name:ALLSTAR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EXOP
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-825-4190
Mailing Address - Street 1:5615 OLD NATIONAL HWY STE D
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3817
Mailing Address - Country:US
Mailing Address - Phone:678-825-4190
Mailing Address - Fax:678-368-4250
Practice Address - Street 1:5615 OLD NATIONAL HWY STE D
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3817
Practice Address - Country:US
Practice Address - Phone:678-825-4190
Practice Address - Fax:678-368-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty