Basic Information
| Provider Information | |||||||||
| NPI: | 1013325216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREDWAY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | TYLER | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 ZONOLITE RD NE | ||||||||
| Address2: | STE 13 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303062017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048170900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 860 JOHNSON FY RD NE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042525545 | ||||||||
| FaxNumber: | 4042525511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2014 | ||||||||
| LastUpdateDate: | 10/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT011626 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.