Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT015740 | GA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT015740 | GA |
NPI | 1083366165 |
---|---|
Provider Name | Emily Schmidt |
First Address | Smyrna, GA 30082-2402 |
Second Address | Atlanta, GA 30327-5308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT015740 | GEORGIA BOARD OF PHYSICAL THERAPY (01) | GA |