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Individual

TANNER WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3302 N WOODBINE RD, SAINT JOSEPH, MO 64505-9323
(816) 281-2346
Mailing address
3107 MORTON LN, SAINT JOSEPH, MO 64506-1379
(816) 383-4400

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-03730
KS

Other

Enumeration date
12/17/2020
Last updated
12/17/2020
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