Provider Demographics
NPI:1609172600
Name:HOWARD, THEODORE JEURDON (PTA)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:JEURDON
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 LENOX RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2894
Mailing Address - Country:US
Mailing Address - Phone:404-816-3991
Mailing Address - Fax:404-816-3998
Practice Address - Street 1:3088 LENOX RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-2894
Practice Address - Country:US
Practice Address - Phone:404-816-3991
Practice Address - Fax:404-816-3998
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002507225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant