Provider Demographics
NPI:1184988214
Name:TODD, ELIZABETH (PTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TODD
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 1:3955 ROYAL PENNON CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2175
Mailing Address - Country:US
Mailing Address - Phone:770-689-8137
Mailing Address - Fax:
Practice Address - Street 1:8230 HAZELBRAND RD NE STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1519
Practice Address - Country:US
Practice Address - Phone:770-788-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00770225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant