Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 818 | GA |
N | 2251G0304X | Physical Therapist - Geriatrics | 818 | GA |
N | 2251N0400X | Physical Therapist - Neurology | 818 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | 818 | GA |
NPI | 1205894854 |
---|---|
Provider Name | Thomas Edward Medcalf |
First Address | Chamblee, GA 30366-0804 |
Second Address | Chamblee, GA 30341-2449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |