| Form Physical Therapy Llc | |
|
1295 Hembree Rd Ste A201, Roswell, GA 30076 | |
| (678) 936-0821 | |
| Not Available |
| Full Name | Form Physical Therapy Llc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 1295 Hembree Rd Ste A201, Roswell, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457840290 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT008864 (Georgia) | Primary |
| Provider Name | Blair Alexis Holliday |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891001558 PECOS PAC ID: 5193910628 Enrollment ID: I20101110000828 |
| Provider Name | Brian Matthew Holliday |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1376943274 PECOS PAC ID: 5799007977 Enrollment ID: I20141124002105 |
| Provider Name | Natalie Jacobson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1871105890 PECOS PAC ID: 1557780038 Enrollment ID: I20201001003469 |
| Provider Name | Meghan Alexandria Rud |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1871161778 PECOS PAC ID: 9335511195 Enrollment ID: I20230206000323 |
| Mailing Address | Practice Location Address |
|---|---|
| Form Physical Therapy Llc 4005 Dover Ave, Alpharetta, GA 30009-3283 Ph: (678) 936-0821 | Form Physical Therapy Llc 1295 Hembree Rd Ste A201, Roswell, GA 30076 Ph: (678) 936-0821 |
Mr. Nicholas B Swanner, MPT, GCS Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1000 Applewood Dr, Brookdale Therapy, Roswell, GA 30076 Phone: 404-971-8544 Fax: 414-918-6046 | |
Mrs. Dawnella Grace Harrison, PHYSICAL THERAPIST Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3455 Johnson Ferry Rd Ne, Roswell, GA 30075 Phone: 770-998-6636 | |
Kathryn Hodges Rose, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 11490 Alpharetta Hwy Ste 200, Roswell, GA 30076 Phone: 770-740-8592 Fax: 770-752-9478 | |
Jasmine Elizabeth Ramans, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 10800 Alpharetta Hwy Ste 176, Roswell, GA 30076 Phone: 678-681-1060 Fax: 678-681-9049 | |
Emily Mae Jackson, DPT, OCS Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 87 Vickery St, Roswell, GA 30075 Phone: 404-254-5607 | |
Suzanne Sacks, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 24 E Crossville Rd, Roswell, GA 30075 Phone: 678-822-0721 | |
Ellen Pye, PT, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1570 Holcomb Bridge Rd Ste 205, Roswell, GA 30076 Phone: 678-619-0003 Fax: 678-619-0004 |