Individual
WILMA JENNIFER PITTARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NMT, CMT, LMT
Contact information
Practice address
126 S MILLEDGE AVE, SUITE B, ATHENS, GA 30605-5666
(706) 296-8000
Mailing address
PO BOX 343, ATHENS, GA 30603-0343
(706) 296-8000
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT003330
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT003330
GEORGIA STATE MASSAGE LICENSURE NUMBER
GA
Enumeration date
09/02/2011
Last updated
09/02/2011
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