MEDICARE: CAROLYN HAX D.P.T.

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	PT010746	GA

General Provider Information

NPI Number	:	1902158405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN HAX D.P.T.

Provider Business Mailing Address
First Line	:	PO BOX 3197
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31799-3197
Country	:	US
Telephone Number	:	229-246-6462
Fax Number	:	229-246-9959

Provider Business Practice Location Address
First Line	:	117 S. DONALSON ST.
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-5901
Country	:	US
Telephone Number	:	229-246-6462
Fax Number	:	229-246-9959

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

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	08/31/2015

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