Provider Demographics
NPI:1992995229
Name:RAMOS, MEDARDO M (PT)
Entity type:Individual
Prefix:
First Name:MEDARDO
Middle Name:M
Last Name:RAMOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CREEKWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-7339
Mailing Address - Country:US
Mailing Address - Phone:229-349-0437
Mailing Address - Fax:
Practice Address - Street 1:110 CREEKWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-7339
Practice Address - Country:US
Practice Address - Phone:229-349-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist