| NPI | 1740325893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE L. KING Administrator 706-869-7495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT001809) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |