Individual
LISA ALEJANDRA WILBUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
485 HUNTINGTON RD, SUITE194, ATHENS, GA 30606-1861
(706) 548-5922
(706) 549-9354
Mailing address
1250 CALLS CREEK CIR, WATKINSVILLE, GA 30677-2599
(706) 612-0309
(706) 549-9354
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT005128
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT005128
STATE LICENSE
GA
Enumeration date
02/07/2012
Last updated
02/07/2012
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