Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT006834 | GA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT006834 | GA |
NPI | 1033224415 |
---|---|
Provider Name | Mrs. Elizabeth Gold Glass |
First Address | Savannah, GA 31406-3291 |
Second Address | Savannah, GA 31405-5531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 08/07/2007 |