Individual
EMILY KAY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
208 EDGEMONT BLVD, ALAMOSA, CO 81101-2320
(719) 587-8246
Mailing address
1307 W 11TH ST UNIT 11, ALAMOSA, CO 81101-3358
(580) 484-0966
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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