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Contact Information

PHYSICALLY EMPOWERED THERAPY & WELLNESS
2300 SUGARLEAF TRAIL
HAMPTON, GA30228
 Phone: 770-203-5144
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for PHYSICALLY EMPOWERED THERAPY & WELLNESS

NPI # 1114215233
LBN Legal business name PHYSICALLY EMPOWERED THERAPY & WELLNESS
Authorized official JEANCARLO ALENCASTRO - (CLINIC OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/11/2011
Last updated 08/01/2018 - About 8 years ago
Identifiers
GA License # AT001665
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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