MEDICARE: JANETTE VIRGINIA PIEDRA PT, DPT

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	PT5761	NM
2	225100000X	Physical Therapist	PT004701	WV
3	225100000X	Physical Therapist	PT017488	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT004701	OTHER	WV	WEST VIRGINIA BOARD OF PHYSICAL THERAPY
2	PT5761	OTHER	NM	STATE OF NEW MEXICO PHYSICAL THERAPY BOARD

General Provider Information

NPI Number	:	1205513157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANETTE VIRGINIA PIEDRA PT, DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 HIGHWAY 129 S STE B
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-4945
Country	:	US
Telephone Number	:	706-219-4507
Fax Number	:

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	12/11/2024

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