Provider Demographics
NPI:1609106418
Name:REID CLINIC SPORTS PHYSICAL THERAPY AND SPINE LLC
Entity type:Organization
Organization Name:REID CLINIC SPORTS PHYSICAL THERAPY AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REID
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-667-3435
Mailing Address - Street 1:11660 ALPHARETTA HWY
Mailing Address - Street 2:STE 560
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3883
Mailing Address - Country:US
Mailing Address - Phone:678-667-3435
Mailing Address - Fax:
Practice Address - Street 1:11660 ALPHARETTA HWY STE 560
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3883
Practice Address - Country:US
Practice Address - Phone:678-667-3435
Practice Address - Fax:404-201-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009889261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy