Individual
MRS. LISA N. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(706) 845-3192
(706) 845-3700
Mailing address
536 PINE AVE, ROANOKE, AL 36274-1446
(334) 863-6844
(706) 845-3700
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA000264
GA
Other
Enumeration date
06/07/2007
Last updated
07/08/2007
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