Provider Demographics
NPI:1861894743
Name:GALUTERA, JB CONCORDIO III (PT)
Entity type:Individual
Prefix:MR
First Name:JB CONCORDIO
Middle Name:
Last Name:GALUTERA
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 HOWELL MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2108
Mailing Address - Country:US
Mailing Address - Phone:404-351-8410
Mailing Address - Fax:
Practice Address - Street 1:3921 OLD ATLANTA STATION DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-1984
Practice Address - Country:US
Practice Address - Phone:850-766-1672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29656225100000X
GAPT011738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist