Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA002985 | GA |
NPI | 1003374216 |
---|---|
Provider Name | Mrs. Rebekah Bruner |
First Address | Monroe, GA 30655-8525 |
Second Address | Athens, GA 30606-4067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2019 |
Last Update Date | 06/03/2019 |