Individual
EMILY MARY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5447 E BEAUMONT CENTER BLVD, TAMPA, FL 33634-5210
(888) 754-0398
Mailing address
5447 E BEAUMONT CENTER BLVD, TAMPA, FL 33634-5210
(188) 875-4039
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9476841788
—
FL
Enumeration date
01/20/2023
Last updated
01/20/2023
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