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Organization
TRI-STATE REHABILITATION
Active
Organization
TRI-STATE REHABILITATION
Active
Other names
Valdosta Pediatric Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNA DELOACH PT (PHYSICAL THERAPIST)
(229) 253-8500
Entity
Organization
Contact information
Practice address
202 W PARK AVE, VALDOSTA, GA 31602-2507
(229) 253-8500
(229) 253-8522
Mailing address
202 W PARK AVE, VALDOSTA, GA 31602-2507
(229) 253-8500
(229) 253-8522
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002693
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000802425A
—
GA
01
—
257139725
TRICARE
GA
01
—
52592064 - 001
BLUE CROSS BLUE SHIELD
GA
Enumeration date
01/18/2007
Last updated
06/23/2008
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