Provider Demographics
NPI:1114931912
Name:NASH, MITZI I (PT)
Entity Type:Individual
Prefix:MRS
First Name:MITZI
Middle Name:I
Last Name:NASH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RIVERBEND DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-4102
Mailing Address - Country:US
Mailing Address - Phone:404-276-7904
Mailing Address - Fax:678-432-2475
Practice Address - Street 1:110 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-4102
Practice Address - Country:US
Practice Address - Phone:404-276-7904
Practice Address - Fax:678-432-2475
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT4371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist