Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA001624 | GA |
NPI | 1023071420 |
---|---|
Provider Name | Ms. Geraldine Bridges |
First Address | Moultrie, GA 31768 |
Second Address | Moultrie, GA 31768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 08/07/2007 |