Provider Demographics
NPI:1073887576
Name:ABRAHAM, BETTY J (PTA, LMT)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:J
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA, LMT
Mailing Address - Street 1:565 OAK TRL
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2793
Mailing Address - Country:US
Mailing Address - Phone:229-444-3665
Mailing Address - Fax:
Practice Address - Street 1:565 OAK TRL
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2793
Practice Address - Country:US
Practice Address - Phone:229-444-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002748225200000X
GAMT009464225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant