Provider Demographics
NPI:1922580042
Name:FORRESTER, ZOEY THEA
Entity Type:Individual
Prefix:
First Name:ZOEY
Middle Name:THEA
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30558-5819
Mailing Address - Country:US
Mailing Address - Phone:706-983-9130
Mailing Address - Fax:
Practice Address - Street 1:711 W RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30558-5819
Practice Address - Country:US
Practice Address - Phone:706-983-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty