Organization · Type 2 NPI

1source Fitness & Sports Neuro Rehab

Home Health Agency · Snellville, GA

NPI number 1184174161 Active

Practice location

4728 Joseph Eli Dr
Snellville, GA 30039-7138

Fax (678) 257-4037

Specialties and licenses

Taxonomy	Code	License
Home Health Agency Primary	251E00000X	12002969 (GA)

Home Health Agency: A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organ…

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NPI record

NPI: 1184174161
Entity type: Organization (Type 2)
Issued: Oct 13, 2016
Last updated: Oct 13, 2016
Status: Active
Subpart: Yes of 1source Fitness & Sports Neuro Rehab

Other names

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1source Health Services · other name

Authorized official

Collin Adu, DPT.GCS. MBA
Clinical Director
(678) 250-4035

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1184174161

1source Fitness & Sports Neuro Rehab's National Provider Identifier is 1184174161, issued on Oct 13, 2016. The primary taxonomy on file is Home Health Agency (251E00000X), and the practice location is in Snellville, GA. The record was last updated on Oct 13, 2016.