MEDICARE: CINDY WORTHAM

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	PTA000509	GA

General Provider Information

NPI Number	:	1326572124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY WORTHAM

Provider Business Mailing Address
First Line	:	3001 SPRING FOREST RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-2815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11190 MEDLOCK BRIDGE RD
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-2578
Country	:	US
Telephone Number	:	470-237-0807
Fax Number	:

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

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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Directions to “ CINDY WORTHAM ” Practice Location

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