Healthcare Provider Details

I. General information

NPI: 1831561513
Provider Name (Legal Business Name): REBECA MORRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CARTER ST
RICHMOND HILL GA
31324-3673
US

IV. Provider business mailing address

144 CARTER ST
RICHMOND HILL GA
31324-3673
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-6131
  • Fax:
Mailing address:
  • Phone: 912-756-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA002960
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: