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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336352079 NPPES
Georgia MEDICAID 739344620C

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