Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 001900 | GA |
NPI | 1003151218 |
---|---|
Provider Name | Julee Ginn |
First Address | Athens, GA 30606-8398 |
Second Address | Athens, GA 30606-8398 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2012 |
Last Update Date | 29/11/2012 |