Individual
SHANNON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3108 CIRCLE DR, WHITE PINE, TN 37890-3306
(865) 674-7454
Mailing address
PO BOX 150, LIMA, OH 45802-0150
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7143
TN
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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