Individual
MR. MARIO JAMES WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
235 W 75TH ST, NEW YORK, NY 10023-0328
(646) 518-5559
Mailing address
16 DOGWOOD DR, MIDDLETOWN, NY 10940-1802
(845) 956-3453
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
052204
NY
Other
Enumeration date
04/16/2024
Last updated
04/16/2024
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