Individual
MS. EILEEN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, PTA
Contact information
Practice address
10 ARTHUR AVE, LONG BRANCH, NJ 07740-6402
(732) 222-3839
Mailing address
10 ARTHUR AVE, LONG BRANCH, NJ 07740-6402
(732) 222-3839
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00040000
NJ
Other
Enumeration date
04/08/2007
Last updated
07/21/2022
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