Provider Demographics
NPI:1902411390
Name:STRATTON, LOUISE IRMA (PTA)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:IRMA
Last Name:STRATTON
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 1:4035 HOMESTEAD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5646
Mailing Address - Country:US
Mailing Address - Phone:803-984-1662
Mailing Address - Fax:
Practice Address - Street 1:3875 POST RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-5354
Practice Address - Country:US
Practice Address - Phone:770-886-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004514225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant