MEDICARE: MS. PIMA S. MCCONNELL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT001885	GA

General Provider Information

NPI Number	:	1114953411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PIMA S. MCCONNELL PT

Provider Business Mailing Address
First Line	:	50 CONNIE CIR
Second Line	:
City	:	PINE MOUNTAIN
State	:	GA
Zip	:	31822-4712
Country	:	US
Telephone Number	:	706-977-0846
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 S COLLEGE ST
Second Line	:
City	:	HAMILTON
State	:	GA
Zip	:	31811-5306
Country	:	US
Telephone Number	:	706-628-4622
Fax Number	:	706-628-9159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	01/22/2010

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