Provider Demographics
NPI:1548034507
Name:FIXTPT LAWRENCEVILLE LLC
Entity type:Organization
Organization Name:FIXTPT LAWRENCEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOROKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-779-7050
Mailing Address - Street 1:455 PHILIP BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8767
Mailing Address - Country:US
Mailing Address - Phone:404-799-7050
Mailing Address - Fax:
Practice Address - Street 1:455 PHILIP BLVD STE 135
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8767
Practice Address - Country:US
Practice Address - Phone:404-799-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy