Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT006623 | GA |
NPI | 1003181504 |
---|---|
Provider Name | Mrs. Julie G Cleveland |
First Address | Lawrenceville, GA 30046-3390 |
Second Address | Lawrenceville, GA 30046-3390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2012 |
Last Update Date | 15/03/2012 |