Individual
RICHARD LANCE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1034 BUCHANAN BRIDGE RD, CHESTERFIELD, SC 29709-6154
(843) 623-9232
(843) 320-1003
Mailing address
1034 BUCHANAN BRIDGE RD, CHESTERFIELD, SC 29709-6154
(843) 623-9232
(843) 320-1003
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2559
SC
Other
Enumeration date
05/05/2009
Last updated
05/05/2009
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