Provider Demographics
NPI:1972755957
Name:PRINCE, GAYLA K (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:GAYLA
Middle Name:K
Last Name:PRINCE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5005 FRIENDSHIP RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1715
Mailing Address - Country:US
Mailing Address - Phone:770-271-3458
Mailing Address - Fax:770-271-8036
Practice Address - Street 1:4591 WINDER HWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3610
Practice Address - Country:US
Practice Address - Phone:770-967-1466
Practice Address - Fax:770-967-8953
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPT009398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist