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General NPI Number Information
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NPI Number | 1205390473
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Entity Type | Individual
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Provider Name | LAURA WILEY PT
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 1266 W PACES FERRY RD NW STE 664
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City | ATLANTA
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State | GA
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Zip | 30327-2306
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Country | US
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Telephone | 404-467-7780
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Fax | 770-664-8626
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Provider Business Mailing Address
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Address Line | 888 MUIRFIELD TRL
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City | MARIETTA
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State | GA
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Zip | 30068-2654
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Country | US
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Telephone | 404-432-9224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4917
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License Number State | GA
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