Organization
PHYSIO
Active
Organization
PHYSIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURRI WALLACE PT,DPT,MHS (AREA VICE PRESIDENT)
(678) 459-7792
Entity
Organization
Contact information
Practice address
100 MOUNTAIN VIEW DR, SUITE 100, CUMMING, GA 30040-2434
(770) 889-2163
(770) 889-4385
Mailing address
100 MOUNTAIN VIEW DR, SUITE 100, CUMMING, GA 30040-2434
(770) 889-2163
(770) 889-4385
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT012173
GA
Other
Enumeration date
12/17/2015
Last updated
12/17/2015
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