Provider Demographics
NPI:1174135743
Name:REHABILITATION AND WOUNDCARE INSTITUTE LLC
Entity type:Organization
Organization Name:REHABILITATION AND WOUNDCARE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEVONTMAKHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:678-662-8918
Mailing Address - Street 1:125 TERRAMONT CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2527
Mailing Address - Country:US
Mailing Address - Phone:678-662-8918
Mailing Address - Fax:
Practice Address - Street 1:6330 PRIMROSE HILL CT STE 205
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4544
Practice Address - Country:US
Practice Address - Phone:678-662-8918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty