Individual
MR. JOHN ROBERT WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
103 W WOODHILL DR, SUITE A, NAGS HEAD, NC 27959
(252) 441-8580
(252) 441-9551
Mailing address
PO BOX 716, KILL DEVIL HILLS, NC 27948
(252) 441-8580
(252) 441-9551
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5301
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7285489
—
NC
Enumeration date
03/06/2007
Last updated
03/10/2020
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