Healthcare Provider Details

I. General information

NPI: 1396023537
Provider Name (Legal Business Name): BRITTANY VIDETTO MORRIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY ASHTON VIDETTO PTA

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 MAGNOLIA WAY
AUGUSTA GA
30909-9481
US

IV. Provider business mailing address

1706 MAGNOIA WAY
AUGUSTA GA
30909
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-7529
  • Fax:
Mailing address:
  • Phone: 706-210-7529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA002785
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: