Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT011565 | GA |
NPI | 1033656806 |
---|---|
Provider Name | Adam Holzwarth |
First Address | Atlanta, GA 30342-1725 |
Second Address | Atlanta, GA 30342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2017 |
Last Update Date | 31/01/2017 |