Individual
MELISSA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
582 HWY 365 STE 3, MAYFLOWER, AR 72106
(501) 470-3500
(501) 470-3502
Mailing address
3930 GABRIAL DRIVE, CONWAY, AR 72034-3366
(501) 470-3500
(501) 470-3502
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1824
AR
Other
Enumeration date
12/23/2011
Last updated
12/23/2011
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