Individual
TIFFANY LEWALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15476B DEDEAUX RD, GULFPORT, MS 39503-2637
(228) 539-3232
Mailing address
251 JOHNSTON ST SE, SUITE 300, DECATUR, AL 35601-2515
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/25/2016
Last updated
08/25/2016
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