Provider Demographics
NPI:1104987791
Name:VOLLRATH, JANET (RPT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:VOLLRATH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 PONY GHOST TRL
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-7550
Mailing Address - Country:US
Mailing Address - Phone:706-632-4418
Mailing Address - Fax:706-632-9756
Practice Address - Street 1:259 PONY GHOST TRL
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-7550
Practice Address - Country:US
Practice Address - Phone:706-632-4418
Practice Address - Fax:706-632-9756
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00830893AMedicaid
GA00830893AMedicaid