Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT0002661 | GA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT002661 | GA |
N | 2251S0007X | Physical Therapist - Sports | PT002661 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT002661 | GA |
NPI | 1336196948 |
---|---|
Provider Name | Brad Stephen Freemyer |
First Address | Roswell, GA 30075-2220 |
Second Address | Roswell, GA 30075-2220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 08/08/2007 |