Organization
THERAPY TRAILS OF EVANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH PEAVY (OWNER/SLP)
(706) 842-3330
Entity
Organization
Contact information
Practice address
536 GRAND SLAM DR STE D, EVANS, GA 30809-8045
(706) 854-8434
(706) 854-8435
Mailing address
536 GRAND SLAM DR STE D, EVANS, GA 30809-8045
(706) 854-8434
(706) 854-8435
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
706-854-8434
PHONE NUMBER
—
Enumeration date
09/05/2019
Last updated
09/05/2019
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