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NPI Code Detail

MEDICARE: MS. BRENNA JARVIS PTA

MEDICARE: MS. BRENNA JARVIS PTA
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
1225200000XPhysical Therapy AssistantPTA003375GA
2225200000XPhysical Therapy Assistant06004984AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PTA003375OTHERGAGEORGIA PTA LICENSE NUMBER

General Provider Information

NPI Number : 1306244975
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRENNA JARVIS PTA
Provider Business Mailing Address
First Line : 1924 N LEG RD
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-4451
Country : US
Telephone Number : 812-243-1179
Fax Number :
Provider Business Practice Location Address
First Line : 1043 WASHINGTON RD
Second Line :
City : THOMSON
State : GA
Zip : 30824-7318
Country : US
Telephone Number : 706-597-1190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2014
Last Update Date : 12/15/2014

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Directions to “ MS. BRENNA JARVIS PTA” Practice Location

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