Individual
AMY WALLENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T., M.P.T.
Contact information
Practice address
26 N STATE ST, SUITE 400, ZEELAND, MI 49464-1281
(616) 772-5643
(616) 772-5819
Mailing address
26 N STATE ST, SUITE 400, ZEELAND, MI 49464-1281
(616) 772-5643
(616) 772-5819
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5501012840
MI
2251P0200X
Pediatric Physical Therapist
Primary
5501012840
MI
Other
Enumeration date
08/22/2010
Last updated
09/05/2010
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