Individual
MS. THERESA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OWNER
Contact information
Practice address
1200 AC EVANS ST APT 2, RIVIERA BEACH, FL 33404-2063
(561) 634-6091
(561) 828-2343
Mailing address
1200 AC EVANS ST APT 2, RIVIERA BEACH, FL 33404-2063
(561) 634-6091
(561) 828-2343
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
FL
Other
Enumeration date
08/27/2018
Last updated
08/27/2018
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