Individual
MRS. CAROLYN ANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2070 MCKENZIE RD STE C, SPRINGDALE, AR 72762-0870
(479) 750-7778
(479) 750-7708
Mailing address
177 ROGGERO RD APT 10, TONTITOWN, AR 72762-4520
(580) 278-1104
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4984
AR
Other
Enumeration date
10/21/2024
Last updated
10/21/2024
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