Individual
MR. BRIAN EUGENE VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
40095 US HIGHWAY 441, ELITE PHYSICAL THERAPY, COMMERCE, GA 30529
(706) 335-3816
(706) 335-3819
Mailing address
2129 UNITY CHURCH CIRCLE, MAYSVILLE, GA 30558
(706) 652-3907
(706) 335-3819
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004868
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00981439A
—
GA
Enumeration date
10/17/2006
Last updated
07/08/2007
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