Individual
LETITIA WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2455 OAK GROVE CHURCH RD, CARROLLTON, GA 30117-9513
(770) 834-1737
Mailing address
PO BOX 5034, KINGSHILL, VI 00851-5034
(340) 473-1688
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001912
GA
Other
Enumeration date
09/14/2017
Last updated
09/14/2017
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