Individual
JENNIFER WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC/L
Contact information
Practice address
806 PATTON CHAPEL TRL, HOOVER, AL 35226-2254
(256) 436-1165
Mailing address
806 PATTON CHAPEL TRL, HOOVER, AL 35226-2254
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1197
AL
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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