Provider Demographics
NPI:1063620037
Name:MEADOWS HAND AND PHYSICAL THERAPY CLINIC
Entity type:Organization
Organization Name:MEADOWS HAND AND PHYSICAL THERAPY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPASI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT, CHT
Authorized Official - Phone:770-623-0105
Mailing Address - Street 1:9700 MEDLOCK BRIDGE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4409
Mailing Address - Country:US
Mailing Address - Phone:770-623-0105
Mailing Address - Fax:678-377-1737
Practice Address - Street 1:9700 MEDLOCK BRIDGE RD STE 150
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4409
Practice Address - Country:US
Practice Address - Phone:770-623-0105
Practice Address - Fax:678-377-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004486225100000X, 2251H1200X
GAPT007815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5163970001Medicare NSC
GAGRP6380Medicare ID - Type Unspecified
GA65BBFBCMedicare ID - Type Unspecified
GA65BBBMFMedicare ID - Type Unspecified