Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT010545 | GA |
NPI | 1003101064 |
---|---|
Provider Name | Veronica V Edwards |
First Address | Marietta, GA 30067-6106 |
Second Address | Marietta, GA 30067-5442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 06/01/2014 |