| NPI | 1760848345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARA ELIZABETH BETZ Sole Member/Sole Provider 706-767-4419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT008282) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2016-01-12 |