Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT000748 | GA |
N | 2251H1200X | Hand | 9105000229 | GA |
NPI | 1295732469 |
---|---|
Provider Name | Sandra C Colhard |
First Address | Rome, GA 30162-0949 |
Second Address | Rome, GA 30165-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2005 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00359217 | RR MEDICARE (01) | GA |