Individual
KIM MICHELE WYRWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3615 BRASELTON HWY, STE. 101, DACULA, GA 30019-5906
(770) 904-0772
(770) 904-0774
Mailing address
2035 WISTERIA CT, LAWRENCEVILLE, GA 30044-2891
(770) 962-2632
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001703
GA
Other
Enumeration date
06/20/2007
Last updated
07/08/2007
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