Provider Demographics
NPI:1518573872
Name:ZONA PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ZONA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:MBENYI
Authorized Official - Last Name:EZEANYA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:862-202-6596
Mailing Address - Street 1:302 SATELLITE BLVD NE STE 111
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7182
Mailing Address - Country:US
Mailing Address - Phone:678-765-0909
Mailing Address - Fax:
Practice Address - Street 1:302 SATELLITE BLVD NE STE 111
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7182
Practice Address - Country:US
Practice Address - Phone:862-202-6596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty