Provider Demographics
NPI:1730795980
Name:REVELLE PHYSICAL THERAPY
Entity type:Organization
Organization Name:REVELLE PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MTC
Authorized Official - Phone:478-954-9311
Mailing Address - Street 1:5502 PEACHTREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2314
Mailing Address - Country:US
Mailing Address - Phone:478-954-9311
Mailing Address - Fax:
Practice Address - Street 1:5502 PEACHTREE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2310
Practice Address - Country:US
Practice Address - Phone:770-800-2377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255745592OtherNPI
GA1588059380OtherNPI
1568611986OtherNPI
1053651026OtherNPI
1225661184OtherNPI
1477007342OtherNPI
1730598863OtherNPI