MEDICARE: DR. SOPHIA ANYANWU-TYSON DPT

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	PT014204	GA

General Provider Information

NPI Number	:	1477199479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA ANYANWU-TYSON DPT

Provider Business Mailing Address
First Line	:	5255 SNAPFINGER PARK DR STE 130
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-4066
Country	:	US
Telephone Number	:	770-322-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 SNAPFINGER PARK DR STE 130
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-4066
Country	:	US
Telephone Number	:	770-322-7003
Fax Number	:

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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