Organization
LAKE DOW PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLEY M JEDDING DPT, CEAS (PRESIDENT)
(678) 583-6345
Entity
Organization
Contact information
Practice address
42 OLD JACKSON RD, MCDONOUGH, GA 30252-3029
(678) 583-6345
(678) 583-6346
Mailing address
42 OLD JACKSON RD, MCDONOUGH, GA 30252-3029
(678) 583-6345
(678) 583-6346
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT006775
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT006775
PT LISCENSE
GA
Enumeration date
02/16/2008
Last updated
06/17/2008
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