Organization
JELLY BEANS PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA SWAN PT (OWNER)
(912) 659-8099
Entity
Organization
Contact information
Practice address
37 W FAIRMONT AVE STE 321, SAVANNAH, GA 31406-3459
(912) 659-8099
(912) 257-7315
Mailing address
PO BOX 15422, SAVANNAH, GA 31416-2122
(912) 659-8099
(912) 257-7315
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
GA006299
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000944501G
—
GA
Enumeration date
01/28/2018
Last updated
04/03/2022
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