Individual
MACI WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4630 WOODMERE BLVD, MONTGOMERY, AL 36106-2906
(334) 387-0575
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(334) 387-0575
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
04/30/2025
Last updated
08/11/2025
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