Individual
COURTNEY BROOKE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3601 WINDEMERE PL, RALEIGH, NC 27604-5961
(919) 601-0149
Mailing address
9802 CARVEL CT, RALEIGH, NC 27613-5754
(984) 200-2415
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
8974
NC
Other
Enumeration date
04/06/2009
Last updated
01/22/2021
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