Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT013261 | GA |
NPI | 1336772326 |
---|---|
Provider Name | Hafiza Fazal |
First Address | Fayetteville, GA 30214-7636 |
Second Address | Fayetteville, GA 30214-7636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2020 |
Last Update Date | 18/02/2020 |