Individual
WALLACE LEE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 SAINT FRANCIS DR, BRADFORD, PA 16701-1868
(814) 688-1531
Mailing address
763 PRIEST HOLLOW RD, RUSSELL, PA 16345-4633
(814) 688-1531
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE1003187
PA
Other
Enumeration date
04/14/2018
Last updated
04/14/2018
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