Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 2388 | GA |
N | 2251H1200X | Hand | 2388 | GA |
NPI | 1710955513 |
---|---|
Provider Name | Mrs. Rebecca L Eisman |
First Address | Lilburn, GA 30047-1826 |
Second Address | Lilburn, GA 30047-1826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S84573 | (02) | GA |