Provider Demographics
NPI:1205959079
Name:PLUMMER, RENITA UPSHAW (PT)
Entity type:Individual
Prefix:
First Name:RENITA
Middle Name:UPSHAW
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WOODVALE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0697
Mailing Address - Country:US
Mailing Address - Phone:478-272-6241
Mailing Address - Fax:
Practice Address - Street 1:SELECT MEDICAL
Practice Address - Street 2:GWVH HIGHWAY 112
Practice Address - City:MILLEDEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-453-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist