Individual
MAUREEN V WALLACE
Active
Individual
MAUREEN V WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1931
MT
225100000X
Physical Therapist
1931PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000061621
BCBS MT
MT
05
—
3402057
—
MT
Enumeration date
07/15/2006
Last updated
11/23/2009
Update your record
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