Individual
GEORGIANA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
953 DANBY RD, ITHACA, NY 14850-7002
(240) 429-6986
Mailing address
953 DANBY RD, ITHACA, NY 14850-7002
(240) 429-6986
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/17/2025
Last updated
09/17/2025
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