Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT000971 | GA |
NPI | 1003113846 |
---|---|
Provider Name | Debra Beazley |
First Address | Augusta, GA 30904-7803 |
Second Address | Augusta, GA 30904-7803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2011 |
Last Update Date | 14/02/2011 |