Individual
JOSE ABANTAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-3347
(229) 353-7722
Mailing address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-3347
(229) 353-7722
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT004580
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT004580
LICENSE NUMBER
GA
Enumeration date
03/30/2007
Last updated
07/08/2007
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