Doctor Name: | MRS. LILLIAN STENSON WALLACE |
NPI Number: | 1538323720 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | PT004075 |
Business Practice Address: | 105 Kimberwick Trl Newnan, GA - 302637110 |
Business Phone Number: | 4043141933 |
Business Fax Number: | 7702519817 |
Mailing Address: | 105 Kimberwick Trl, NEWNAN |
State: | GA |
Postal Code: | 302637110 |
Phone Number: | 4043141933 |
Fax Number: | 7702519817 |
NPI Enumeration Date: | 07/16/2008 |
NPI Last Update Date: | 07/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT004075 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |