Provider Demographics
NPI:1407811516
Name:ALDRIDGE, ELIZABETH R (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:R
Other - Last Name:ALDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:812 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4412
Mailing Address - Country:US
Mailing Address - Phone:770-834-7436
Mailing Address - Fax:770-830-5954
Practice Address - Street 1:812 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4412
Practice Address - Country:US
Practice Address - Phone:770-834-7436
Practice Address - Fax:770-830-5954
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist