Individual
MACKENSON LAFORTUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1424 FILIGREE PL, DACULA, GA 30019
(678) 790-2882
Mailing address
1424 FILIGREE PL, DACULA, GA 30019-7528
(678) 790-2882
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
—
FL
225200000X
Physical Therapy Assistant
Primary
—
GA
Other
Enumeration date
10/29/2019
Last updated
09/28/2021
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