Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT009764 | GA |
NPI | 1457719346 |
---|---|
Provider Name | Dr. Randy Trumbower |
First Address | Avondale Estates, GA 30002-1773 |
Second Address | Atlanta, GA 30322-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2016 |
Last Update Date | 05/02/2016 |