Individual
STANLEY TODD BRUCE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1451 NEWTON DR, TIFTON, GA 31794-3752
(229) 392-4426
Mailing address
1451 NEWTON DR, TIFTON, GA 31794-3752
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002917
GA
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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