Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | GA |
NPI | 1326502303 |
---|---|
Provider Name | Megan Elizabeth Maxwell |
First Address | Gainesville, GA 30506-3721 |
Second Address | Gainesville, GA 30506-3721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2019 |
Last Update Date | 24/01/2019 |