Provider Demographics
NPI:1053694687
Name:POWER PHYSICAL THERAPY
Entity type:Organization
Organization Name:POWER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUFUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEJOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-218-7290
Mailing Address - Street 1:2852 DELK RD SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2852 DELK RD SE
Practice Address - Street 2:SUITE 202
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6371
Practice Address - Country:US
Practice Address - Phone:678-384-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy