MEDICARE: ELIZABETH TODD PTA

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	225200000X	Physical Therapy Assistant	00770	GA

General Provider Information

NPI Number	:	1184988214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH TODD PTA

Provider Business Mailing Address
First Line	:	3955 ROYAL PENNON CT
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30092-2175
Country	:	US
Telephone Number	:	770-689-8137
Fax Number	:

Provider Business Practice Location Address
First Line	:	8230 HAZELBRAND RD NE STE A
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-1519
Country	:	US
Telephone Number	:	770-788-7034
Fax Number	:

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

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	07/03/2012

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