Individual
COLLIN WILLIAM WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
11375 BIG BEND RD, RIVERVIEW, FL 33579-7183
(813) 805-8167
(844) 214-1382
Mailing address
11375 BIG BEND RD, RIVERVIEW, FL 33579-7183
(813) 805-8167
(844) 214-1382
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
30787
FL
225100000X
Physical Therapist
PT30787
FL
2251X0800X
Orthopedic Physical Therapist
Primary
PT30787
FL
Other
Enumeration date
09/04/2015
Last updated
03/02/2026
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