Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 000472 | GA |
NPI | 1013416312 |
---|---|
Provider Name | Sonja Byars |
First Address | Decatur, GA 30034-4788 |
Second Address | Decatur, GA 30034-4788 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2018 |
Last Update Date | 02/02/2018 |