Individual
MISS DAPHNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
120 OSLO CIR, BIRMINGHAM, AL 35211-5965
(205) 944-3944
(205) 413-4914
Mailing address
120 OSLO CIR, BIRMINGHAM, AL 35211-5965
(205) 944-3944
(205) 413-4914
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PTH4642
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-30526
BCBS
AL
01
—
51532180
BCBS PROVIDER # FOR ARC
AL
05
—
890015770
—
AL
Enumeration date
09/01/2006
Last updated
03/06/2019
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