Provider Demographics
NPI:1972671345
Name:GEORGE, CONSTANCE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 FLOWER ST APT T
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4777
Mailing Address - Country:US
Mailing Address - Phone:714-534-8480
Mailing Address - Fax:
Practice Address - Street 1:15744 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3103
Practice Address - Country:US
Practice Address - Phone:714-895-8248
Practice Address - Fax:714-895-8320
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer