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Individual
WILLIAM C WALLACE
Active
Individual
WILLIAM C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 4793
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4793
PT LICENSE
TN
Enumeration date
07/26/2006
Last updated
06/07/2013
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