Graduated: 2005
NPI: 1144499146
Practice Locations (2)
1SOURCE FITNESS AND SPORTS-NEURO REHAB LLC
367 ATHENS HWY, SUITE 1150
LOGANVILLE, GA 300522270
67825740371002
2336 WISTERIA DR, SUITE 420
SNELLVILLE, GA 300786160
6787534364
Source: CMS National Downloadable File, September 2026.