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General NPI Number Information
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NPI Number | 1992469977
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Entity Type | Individual
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Provider Name | ANITA MARIA THREAT LPTA
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Gender | Female
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 100 WHITLOCK AVE NW
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City | MARIETTA
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State | GA
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Zip | 30064-2362
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Country | US
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Telephone | 770-691-1903
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Fax |
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Provider Business Mailing Address
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Address Line | 8547 W APPLETON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53225-4226
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Country | US
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Telephone | 414-698-7823
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA004656
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License Number State | GA
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