Individual
BETHANY TONEY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
195 MILES ST, ATHENS, GA 30601-1820
(706) 546-1333
Mailing address
195 MILES ST, ATHENS, GA 30601-1820
(706) 546-1333
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT015466
GA
225200000X
Physical Therapy Assistant
PT015466
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT015466
LICENSE NUMBER FROM GEORGIA STATE BOARD OF PHYSICAL THERAPY
GA
Enumeration date
08/06/2021
Last updated
08/06/2021
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