Individual
AMY TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
536 GRAND SLAM DR, EVANS, GA 30809-8014
(706) 854-8434
(706) 854-8435
Mailing address
3115 BRANSFORD RD, AUGUSTA, GA 30909-3007
(706) 364-8393
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
006776
GA
2251X0800X
Orthopedic Physical Therapist
Primary
006776
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006776
PT LICENSE
GA
Enumeration date
04/10/2007
Last updated
09/11/2025
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