Individual
DR. KATIE ETTER WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
597 S ENOTA DR NE, GAINESVILLE, GA 30501-2545
(770) 219-8204
(770) 219-3862
Mailing address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 219-8402
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT007836
GA
Other
Enumeration date
05/02/2007
Last updated
06/06/2013
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