MEDICARE: ELIZABETH OVERSTREET PT

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	PT005013	GA

General Provider Information

NPI Number	:	1801153697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH OVERSTREET PT

Provider Business Mailing Address
First Line	:	415 TOWN PARK BLVD
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-3487
Country	:	US
Telephone Number	:	706-868-1707
Fax Number	:	706-868-1351

Provider Business Practice Location Address
First Line	:	415 TOWN PARK BLVD
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-3487
Country	:	US
Telephone Number	:	706-868-1707
Fax Number	:	706-868-1351

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

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/18/2012

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