Individual
JENNIFER VANHARTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4700 NELSON BROGDON BLVD, SUITE 250, SUGAR HILL, GA 30518-5400
(770) 271-3188
Mailing address
PO BOX 518, JONESBORO, GA 30237-0518
(770) 631-8277
(770) 631-9403
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA001870
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA001870
STATE LISC NUMBER
GA
Enumeration date
11/27/2006
Last updated
07/08/2007
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