Individual
BRIDGETT D'ANN WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7900 SHOAL CREEK BLVD, SUITE 200, AUSTIN, TX 78757-8037
(512) 345-4664
(512) 345-6150
Mailing address
5608 PARKCREST DR, STE 100, AUSTIN, TX 78731-4972
(512) 345-4664
(512) 345-6150
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
Primary
1104610
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050HV
BCBS GROUP #
TX
01
—
030384821
PHCS PROVIDER #
TX
01
—
86683T
BCBS INDIVIDUAL #
TX
Enumeration date
06/05/2006
Last updated
01/31/2019
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