Individual
JUAN WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1901 PHOENIX BLVD, SUITE 205, COLLEGE PARK, GA 30349-5588
(770) 502-1023
Mailing address
PO BOX 518, JONESBORO, GA 30237-0518
(770) 631-8277
(770) 631-9403
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002005
GA
Other
Enumeration date
11/03/2006
Last updated
07/08/2007
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