Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 6870 | GA |
NPI | 1023044948 |
---|---|
Provider Name | Ms. Latefa Nichelle Terry |
First Address | Chattanooga, TN 37416-2913 |
Second Address | La Fayette, GA 30728-2463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/07/2007 |