Most Relevant Information
Provider Data
| NPI Number: | 1003392903 |
| Provider Name: | JUSTIN DESANDRE |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/13/2018 |
| Last Updated: | 07/13/2018 |
Provider Practice Location
4900 IVEY RD NW STE 1001
ACWORTH
GA
301014106
Practice Location Phone/Fax
| Phone: | 7709170924 |
| Fax: |
Provider Mailing Location
PO BOX 724557
ATLANTA
GA
311391557
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |