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General NPI Number Information
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NPI Number | 1013022417
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Entity Type | Individual
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Provider Name | SUSAN HARBISON MAYNE PT
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2217 ROSWELL RD. SUITE A100
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City | MARIETTA
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State | GA
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Zip | 30062
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Country | US
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Telephone | 770-321-6600
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Fax | 770-321-5559
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Provider Business Mailing Address
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Address Line | 310 TECHNOLOGY PKWY
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City | NORCROSS
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State | GA
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Zip | 30092-2932
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Country | US
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Telephone | 770-441-1580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT002955
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License Number State | GA
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