JUAN WALLER

COLLEGE PARK, GA
NPI1780763425
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: GA  PTA002005)
Enumeration Date2006-11-03
Last Update Date2007-07-08
Business Address
-- JUAN WALLER PTA
1901 PHOENIX BLVD SUITE 205
COLLEGE PARK, GA 30349-5588
Phone number: 770-502-1023
Mailing Address
-- JUAN WALLER PTA
PO BOX 518
JONESBORO, GA 30237-0518
Phone number: 770-631-8277
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