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General NPI Number Information
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NPI Number | 1396317251
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Entity Type | Individual
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Provider Name | FALLAN PHAM-REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 147 REINHARDT COLLEGE PKWY STE 9
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City | CANTON
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State | GA
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Zip | 30114-5295
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Country | US
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Telephone | 770-345-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 7545 OLD FIELD COVE RD
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City | CUMMING
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State | GA
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Zip | 30028-8938
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Country | US
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Telephone | 678-983-0103
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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 |
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License Number State |
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