Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA003134 | GA |
NPI | 1003234600 |
---|---|
Provider Name | Renata Mccann |
First Address | Athens, GA 30606-2438 |
Second Address | Athens, GA 30606-2438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 01/04/2014 |