Individual
LISA BEDENBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
142 MARTIN LUTHER KING JR BLVD, MONROE, GA 30655-5620
(770) 207-1137
Mailing address
3787 JACKS CREEK RD NW, MONROE, GA 30655-5352
(770) 266-6005
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5147
LICENSE#
GA
Enumeration date
11/01/2006
Last updated
07/08/2007
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