Provider Demographics
NPI:1225883630
Name:JOY, DESIREE (PTA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:JOY
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 1:1209 ADDISON PL
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9469
Mailing Address - Country:US
Mailing Address - Phone:912-515-9222
Mailing Address - Fax:
Practice Address - Street 1:1209 ADDISON PL
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9469
Practice Address - Country:US
Practice Address - Phone:912-515-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004751225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant