Individual
MARIE L. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPC PERMIT #IP150410
Contact information
Practice address
3606 NORTH RONCHO DR, SUITE 102, LAS VEGAS, NV 89130
(504) 400-5768
Mailing address
10327 BIRCH BLUFF LN, LAS VEGAS, NV 89145
(702) 304-1551
(702) 304-1551
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
07/11/2012
Last updated
05/15/2015
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