Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT007735 | GA |
N | 2251S0007X | Physical Therapist - Sports | PT007735 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT007735 | GA |
NPI | 1114996964 |
---|---|
Provider Name | Mrs. Marilyn Rayburn Shiver |
First Address | Camilla, GA 31730-6749 |
Second Address | Camilla, GA 31730-1807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 25/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
829428929A | (05) | GA |
P00247221 | PALMETTO GBA - RR MEDICAR (01) | |
P97580 | (02) |