Provider Demographics
NPI:1689840035
Name:WALSON, MARI LYNNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:LYNNE
Last Name:WALSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 UNION ST
Mailing Address - Street 2:UNIT 322
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2709
Mailing Address - Country:US
Mailing Address - Phone:770-310-2591
Mailing Address - Fax:678-664-0423
Practice Address - Street 1:318 COLUMBIA DR
Practice Address - Street 2:UNIT 1508
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2050
Practice Address - Country:US
Practice Address - Phone:770-310-2591
Practice Address - Fax:678-664-0423
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist