Individual
HYACINTH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T, DPT
Contact information
Practice address
4008 N CICERO AVE, CHICAGO, IL 60641-1807
(773) 481-0540
Mailing address
105 MARINER HEALTH WAY, STE 213, ST AUGUSTINE, FL 32086-3251
(904) 217-4259
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT31379
FL
Other
Enumeration date
09/24/2014
Last updated
06/14/2018
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