Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT009706 | GA |
NPI | 1053543678 |
---|---|
Provider Name | Tori Pou |
First Address | Dacula, GA 30019 |
Second Address | Gainesville, GA 30501-3773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2009 |
Last Update Date | 17/03/2018 |