Individual
MR. WALTER ERNEST VANHEININGEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
511 GORDON AVE, THOMASVILLE, GA 31792-6645
(229) 228-9019
Mailing address
511 GORDON AVE, THOMASVILLE, GA 31792-6645
(229) 228-9019
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA004191
GA
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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