Healthcare Provider Details

I. General information

NPI: 1306912431
Provider Name (Legal Business Name): BARRY J LALONDE RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 OAKLAND PKWY
LEESBURG GA
31763-7201
US

IV. Provider business mailing address

6262 VETERANS PKWY
COLUMBUS GA
31909-3540
US

V. Phone/Fax

Practice location:
  • Phone: 229-483-0055
  • Fax: 334-732-3646
Mailing address:
  • Phone: 800-324-6661
  • Fax: 334-732-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009736
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: