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Individual

JENNIFER SUNGA MUYCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
201 CROSSTOWN DR, PEACHTREE CITY, GA 30269-3454
(770) 632-5823
Mailing address
10 CANYON VIEW DR, NEWNAN, GA 30265-6089
(678) 986-7701

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009598
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
056033895
DRIVERS LICENSE
GA
Enumeration date
04/21/2018
Last updated
04/21/2018
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