Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | 2226 | NE |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT011222 | GA |
NPI | 1033265319 |
---|---|
Provider Name | Dr. Jeffrey Ebert |
First Address | Peachtree Corners, GA 30092-1004 |
Second Address | Atlanta, GA 30341-4115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 28/09/2015 |