Individual
LINDA W WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
11740 COLUMBIA ST, BLAKELY, GA 39823-2574
(229) 724-4269
(229) 723-2354
Mailing address
11740 COLUMBIA ST, BLAKELY, GA 39823-2574
(229) 724-4269
(229) 723-2354
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0009259
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
688951544A
—
GA
Enumeration date
02/06/2008
Last updated
06/25/2015
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