Jack, Thea Elizabeth
Jack, Thea Elizabeth is an sole proprietor health care provider with primary practice located at 10 Mall Ct Ste B , Savannah GA 31406-3691. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics, which is considered as her primary health care specialty. Jack, Thea Elizabeth can be contacted via phone (912) 713-0277.Contact Information
Primary practice address
10 Mall Ct Ste B
Savannah GA 31406-3691
Phone: (912) 713-0277
Fax: (888) 429-3741
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics | 2251P0200X | PT009479 | Georgia |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics | 2251P0200X | QA01095200 | New Jersey |
Profile Details
NPI number | 1336352079 |
---|---|
LBN Legal business name | Jack, Thea Elizabeth |
Credentials | MPT,PCS |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | May 8th, 2007 |
Last updated | Jul 31st, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1336352079 | NPPES |
Georgia | MEDICAID | 739344620C |
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