Individual
DONALD D WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
605 W STATE ST, FIRST FLOOR, MEDIA, PA 19063-2620
(610) 566-7424
(610) 892-0489
Mailing address
605 W STATE ST, FIRST FLOOR, MEDIA, PA 19063-2620
(610) 566-7424
(610) 892-0489
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT017196
PA
Other
Enumeration date
03/12/2010
Last updated
03/12/2010
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