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General NPI Number Information
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NPI Number | 1912431685
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Entity Type | Organization
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Legal Business Name | GEORGIA MANUAL THERAPY CLINIC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 114 AMELIA DR
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City | BYRON
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State | GA
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Zip | 31008-3503
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Country | US
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Telephone | 478-953-0938
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Fax | 478-918-0253
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Provider Business Mailing Address
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Address Line | 114 AMELIA DR
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City | BYRON
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State | GA
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Zip | 31008-3503
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Country | US
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Telephone | 478-953-0938
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Fax | 478-918-0253
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TORYA L HARRIS
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Credential | LMT, COTA/L
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Telephone | 478-284-8151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT004335
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License Number State | GA
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