Individual
DOUGLAS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
36 HUDSON PL, WEEHAWKEN, NJ 07086-7013
(201) 522-6474
Mailing address
36 HUDSON PL, WEEHAWKEN, NJ 07086-7013
(201) 522-6474
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA00655300
NJ
Other
Enumeration date
04/14/2021
Last updated
04/14/2021
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