Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA003625 | GA |
NPI | 1013487842 |
---|---|
Provider Name | Jennifer Nichole Quigley |
First Address | Chattanooga, TN 37421-4915 |
Second Address | Peachtree City, GA 30269-3077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2018 |
Last Update Date | 05/12/2018 |