Individual
MR. JAMES STEVEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
449 MAIN ST APT 131, ANDERSON, IN 46016-1186
(765) 683-0633
(765) 683-0603
Mailing address
449 MAIN ST APT 131, ANDERSON, IN 46016-1186
(765) 683-0633
(765) 683-0603
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004510A
IN
Other
Enumeration date
12/10/2012
Last updated
12/10/2012
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