Individual
MISS TASHA LYNNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
110 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1500
(770) 461-2928
Mailing address
110 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1500
(770) 461-2928
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
J20000289
DE
225200000X
Physical Therapy Assistant
Primary
PTA002747
GA
Other
Enumeration date
08/04/2011
Last updated
08/04/2011
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