Individual
MRS. LILLIAN STENSON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
105 KIMBERWICK TRL, NEWNAN, GA 30263-7110
(404) 314-1933
(770) 251-9817
Mailing address
105 KIMBERWICK TRL, NEWNAN, GA 30263-7110
(404) 314-1933
(770) 251-9817
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT004075
GA
Other
Enumeration date
07/16/2008
Last updated
07/16/2008
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