Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
Mar 22, 2007
License(s)
8673 (GA), 1180340 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1314 BREEZY LN NE | Atlanta, GA 30329-3543 | 678-697-3329 |
| MAILING | 1735 MAGNOLIA LK | Richmond, TX 77406-7006 | 678-697-3329 |
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