Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 0629 | GA |
NPI | 1396928644 |
---|---|
Provider Name | Mrs. Myrtice Barber Atrice |
First Address | Fairburn, GA 30213-9625 |
Second Address | Atlanta, GA 30309-1426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2007 |
Last Update Date | 10/12/2007 |