Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 05013487A | IN |
N | 2251S0007X | Physical Therapist - Sports | PT015162 | GA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT015162 | GA |
NPI | 1306493812 |
---|---|
Provider Name | Dr. Neil Jacob Haltom |
First Address | Snellville, GA 30078-6160 |
Second Address | Snellville, GA 30078-6160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2019 |
Last Update Date | 04/03/2021 |