Organization
BETHANN WALLACE
Active
Organization
BETHANN WALLACE
Active
Other names
Staunton Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETHANN WALLACE PT PHYSICAL THERAPIS (OWNER)
(540) 213-0345
Entity
Organization
Contact information
Practice address
1416 CHURCHVILLE AVE, SUITE A, STAUNTON, VA 24401
(540) 213-0345
(540) 886-2609
Mailing address
1416 CHURCHVILLE AVE, SUITE A, STAUNTON, VA 24401
(540) 213-0345
(540) 886-2609
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305005759
VA
225100000X
Physical Therapist
235005465
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194028
ANTHEM
VA
Enumeration date
12/19/2006
Last updated
07/14/2008
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