Individual
MRS. LAURA JEAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
4691 WINDFALL RD, MEDINA, OH 44256-8705
(330) 727-7751
Mailing address
10596 CROW RD, LITCHFIELD, OH 44253-9537
(330) 723-5765
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
02040
OH
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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