Individual
MR. JOHN ANTHONY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA, MA
Contact information
Practice address
2702 FARRELL RD, SANFORD, NC 27330-6505
(919) 776-9602
Mailing address
702 MARLIN LN, CLINTON, TN 37716-5982
(865) 898-7448
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12280
NC
Other
Enumeration date
09/23/2009
Last updated
09/23/2009
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