Individual
MR. RANDALL ALLEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
409 E. CALIFORNIA AVE., OAKLAHOMA CITY, OK 73104
(405) 879-6766
(405) 879-3493
Mailing address
18305 ENGLISH OAK LN, EDMOND, OK 73003-4051
(405) 216-8731
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT2855
OK
2251E1200X
Ergonomics Physical Therapist
Primary
PT2855
OK
Other
Enumeration date
11/21/2006
Last updated
09/11/2025
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