Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT002465 | GA |
NPI | 1073575965 |
---|---|
Provider Name | Sandra E. Harbin |
First Address | Douglasville, GA 30134-5631 |
Second Address | Douglasville, GA 30134-5631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 23/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q30230 | (02) | GA |