Provider Demographics
NPI:1548448731
Name:NEUROMUSCULAR ORTHOPEDICS
Entity type:Organization
Organization Name:NEUROMUSCULAR ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-943-1053
Mailing Address - Street 1:4911 HERITAGE TRACE CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6309
Mailing Address - Country:US
Mailing Address - Phone:678-795-9835
Mailing Address - Fax:
Practice Address - Street 1:275 CARPENTER DR NE
Practice Address - Street 2:SUITE 307
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4928
Practice Address - Country:US
Practice Address - Phone:404-943-1053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-10
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004390225700000X, 226300000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA508077OtherCOVENTRY HEALTH CARE
GA52673545OtherBLUE CROSS BLUE SHIELD
582595253OtherCONNECTICUT GENERAL LIFE
582595253OtherCOMMERCE BENEFITS GROUP
KY127648551073OtherHUMANA INSURANCE
GA253829370OtherUNITED HEALTHCARE
0582595253OtherFORTIS INSURANCE