Individual
KATIE A WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1 ARROW DR, WOBURN, MA 01801-2039
(781) 935-2655
(781) 935-9097
Mailing address
5 MERCURY CIR, ANDOVER, MA 01810-2410
(603) 818-9528
(978) 740-4720
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16906
MA
225100000X
Physical Therapist
2972
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020481677
—
ME
01
—
08Y008383NH09
ANTHEM
NH
01
—
098440
ANTHEN
ME
01
—
101051400
US DEPT OF LABOR
NH
01
—
1297438
AETNA
NH
01
—
26206
CIGNA
NH
05
—
30394394
—
NH
01
—
3779390
CIGNA
NH
01
—
755459
TUFTS
NH
01
—
AA51239
HARVARD PILGRIM HEALTH
NH
Enumeration date
06/20/2006
Last updated
09/09/2022
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