Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA004586 | GA |
NPI | 1003405911 |
---|---|
Provider Name | Kyre Lochan |
First Address | Riverdale, GA 30296-2853 |
Second Address | Fayetteville, GA 30214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2021 |
Last Update Date | 15/01/2021 |