Provider Demographics
NPI:1629544465
Name:EIGEL, GRETCHEN ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:EIGEL
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 1:4670 HADLEY PL
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8406
Mailing Address - Country:US
Mailing Address - Phone:770-634-5058
Mailing Address - Fax:
Practice Address - Street 1:4743 ATLANTA HWY STE 100
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2686
Practice Address - Country:US
Practice Address - Phone:770-466-9343
Practice Address - Fax:770-466-9345
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003657225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant