Individual
MISS SOPHIA ANTONIA BLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
2130 ANDERSON MILL RD, AUSTELL, GA 30106-1806
(770) 941-8813
Mailing address
4291 W LINDA DR, DOUGLASVILLE, GA 30134-2617
(678) 576-9652
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001390
GA
Other
Enumeration date
09/20/2018
Last updated
09/20/2018
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