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General NPI Number Information
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NPI Number | 1972755957
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Entity Type | Individual
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Provider Name | GAYLA K PRINCE PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 4591 WINDER HWY
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-3610
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Country | US
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Telephone | 770-967-1466
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Fax | 770-967-8953
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Provider Business Mailing Address
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Address Line | 5005 FRIENDSHIP RD SUITE 300
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City | BUFORD
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State | GA
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Zip | 30518-1715
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Country | US
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Telephone | 770-271-3458
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Fax | 770-271-8036
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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 | PT009398
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License Number State | GA
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