Provider Demographics
NPI:1013325216
Name:TREDWAY, ELIZABETH TYLER (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TYLER
Last Name:TREDWAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 ZONOLITE RD NE
Mailing Address - Street 2:STE 13
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2017
Mailing Address - Country:US
Mailing Address - Phone:404-817-0900
Mailing Address - Fax:
Practice Address - Street 1:860 JOHNSON FY RD NE
Practice Address - Street 2:STE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1435
Practice Address - Country:US
Practice Address - Phone:404-252-5545
Practice Address - Fax:404-252-5511
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist