MEDICARE: MS. JUDY OZERYANSKY P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT005567	GA

General Provider Information

NPI Number	:	1033236609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDY OZERYANSKY P.T.

Provider Business Mailing Address
First Line	:	148 BILL CARRUTH PKWY
Second Line	:	SUITE 120
City	:	HIRAM
State	:	GA
Zip	:	30141-3754
Country	:	US
Telephone Number	:	770-443-7136
Fax Number	:	770-443-7153

Provider Business Practice Location Address
First Line	:	148 BILL CARRUTH PKWY
Second Line	:	SUITE 120
City	:	HIRAM
State	:	GA
Zip	:	30141-3754
Country	:	US
Telephone Number	:	770-443-7136
Fax Number	:	770-443-7153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	06/23/2009

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