Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 9300 | GA |
N | 2251P0200X | Physical Therapist - Pediatrics | 9300 | GA |
NPI | 1093964454 |
---|---|
Provider Name | Amanda Carcone |
First Address | Marietta, GA 30066-0121 |
Second Address | Marietta, GA 30066-1541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 10/09/2008 |