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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