Individual
MR. JOSEPH MICHAEL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8181 NW S RIVER DR LOT B227, MEDLEY, FL 33166-7470
(786) 779-1617
Mailing address
8181 NW S RIVER DR LOT B227, MEDLEY, FL 33166-7470
(786) 779-1617
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA31677
FL
Other
Enumeration date
01/26/2022
Last updated
01/26/2022
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