Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT012873 | GA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT012873 | GA |
NPI | 1508384074 |
---|---|
Provider Name | Jeanne Graf |
First Address | Atlanta, GA 30312-1161 |
Second Address | Smyrna, GA 30080-8504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 06/09/2017 |