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Organization
WALLACE PHYSICAL THERAPY, PLLC
Active
Organization
WALLACE PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDI H WALLACE PT (PRESIDENT)
(315) 416-4327
Entity
Organization
Contact information
Practice address
59A JAMES ST, HOMER, NY 13077-1222
(315) 416-4327
(607) 749-5618
Mailing address
59A JAMES ST, HOMER, NY 13077-1222
(315) 416-4327
(607) 749-5618
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
017462-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000158099
EXCELLUS
NY
05
—
02458611
—
NY
01
—
364724
MVP
NY
01
—
P00162216
MEDICAR RAILROAD
NY
Enumeration date
07/15/2006
Last updated
09/11/2008
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