Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 001833 | GA |
NPI | 1013030113 |
---|---|
Provider Name | Michael Fereday |
First Address | Dalton, GA 30720-5207 |
Second Address | Dalton, GA 30720-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |