Individual
LORI WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
101 PARK CT, GAFFNEY, SC 29341-7021
(864) 206-0006
Mailing address
271 PYRENEES DR, LYMAN, SC 29365
(860) 916-7637
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
000992
CT
225200000X
Physical Therapy Assistant
Primary
3004
SC
Other
Enumeration date
07/23/2009
Last updated
07/21/2022
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