Individual
LESLIE MICHELE WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1034 LAWRENCE ST, EUGENE, OR 97401-3440
(541) 284-2084
(541) 485-1087
Mailing address
1034 LAWRENCE ST, EUGENE, OR 97401-3440
(541) 284-2084
(541) 485-1087
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2726
OR
Other
Enumeration date
01/11/2006
Last updated
07/08/2007
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