Individual
DEIDRE DEANNE HALLONQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4355 GEORGETOWN SQ, DUNWOODY, GA 30338-6266
(770) 644-0862
Mailing address
11077 HIGHWAY 100, HOGANSVILLE, GA 30230-3910
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002494
GA
Other
Enumeration date
10/17/2022
Last updated
10/17/2022
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