Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | PT010154 | GA |
N | 2251S0007X | Physical Therapist - Sports | PT010154 | GA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT010154 | GA |
NPI | 1396042420 |
---|---|
Provider Name | Shreya Tailor |
First Address | Smyrna, GA 30080-6999 |
Second Address | Smyrna, GA 30080-6999 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2011 |
Last Update Date | 25/02/2011 |