Individual
MS. BRENNA JARVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1043 WASHINGTON RD, THOMSON, GA 30824-7318
(706) 597-1190
Mailing address
1924 N LEG RD, AUGUSTA, GA 30909-4451
(812) 243-1179
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06004984A
IN
225200000X
Physical Therapy Assistant
Primary
PTA003375
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA003375
GEORGIA PTA LICENSE NUMBER
GA
Enumeration date
12/15/2014
Last updated
12/15/2014
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