Provider Demographics
NPI:1205007846
Name:ICARD, CHRISTY LYNNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:LYNNE
Last Name:ICARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3632
Mailing Address - Country:US
Mailing Address - Phone:229-924-9595
Mailing Address - Fax:229-924-9540
Practice Address - Street 1:205 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3632
Practice Address - Country:US
Practice Address - Phone:229-924-9595
Practice Address - Fax:229-924-9540
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001828225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant