Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA002181 | GA |
NPI | 1013332873 |
---|---|
Provider Name | Theresa Feanny |
First Address | Locust Grove, GA 30248-7094 |
Second Address | Locust Grove, GA 30248-7094 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2014 |
Last Update Date | 03/03/2014 |