Individual
REBECCA LEASIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2830 TN-394, BLOUNTVILLE, TN 37617
(423) 274-6191
Mailing address
2830 TN-394, BLOUNTVILLE, TN 37617
(731) 446-5628
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
04200
TN
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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