Individual
COLLEEN R WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
20 LAKE ST, BRISTOL, NH 03222-4009
(603) 393-0135
Mailing address
PO BOX 430, BRISTOL, NH 03222-0430
(603) 393-0135
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4692
NH
Other
Enumeration date
08/27/2020
Last updated
11/27/2024
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