Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA003815 | GA |
NPI | 1003312430 |
---|---|
Provider Name | Amanda D Hermida |
First Address | Savannah, GA 31406-6265 |
Second Address | Savannah, GA 31406-3625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 04/04/2018 |