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General NPI Number Information
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NPI Number | 1538381942
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Entity Type | Individual
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Provider Name | ELIZABETH FORDYCE P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1441 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1004
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Country | US
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Telephone | 404-712-5527
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Fax |
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Provider Business Mailing Address
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Address Line | 4434 SIMS CT
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City | TUCKER
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State | GA
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Zip | 30084-3111
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Country | US
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Telephone | 770-908-1526
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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 | PT005618
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License Number State | GA
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