Individual
EDWARD BOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
212 RETREAT VLG STE 212, ST SIMONS ISLAND, GA 31522-2403
(912) 638-1444
(912) 638-0077
Mailing address
PO BOX 949, ROME, GA 30162-0949
(706) 234-9317
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT012047
GA
Other
Enumeration date
08/07/2015
Last updated
01/30/2018
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