Provider Demographics
NPI:1073723409
Name:GEATHERS, PHAEDRA L (MSPT)
Entity type:Individual
Prefix:MRS
First Name:PHAEDRA
Middle Name:L
Last Name:GEATHERS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:PHAEDRA
Other - Middle Name:LAVONYA
Other - Last Name:GEATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:3225 PANTHERS TRCE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3863
Mailing Address - Country:US
Mailing Address - Phone:404-308-0564
Mailing Address - Fax:
Practice Address - Street 1:6849 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:STE 102, BLDG B1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1610
Practice Address - Country:US
Practice Address - Phone:678-587-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist