Individual
LAURRI WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1004 BANKHEAD HWY, BLDG A, STE 5, CARROLLTON, GA 30117-1852
(770) 834-5609
(267) 321-1352
Mailing address
1004 BANKHEAD HWY, BLDG A, STE 5, CARROLLTON, GA 30117-1852
(770) 834-5609
(267) 321-1352
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT006593
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT006593
STATE LISC NUMBER
GA
Enumeration date
11/06/2006
Last updated
05/07/2010
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