Individual
AMANDA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2115 DULLES DR, LAFAYETTE, LA 70506-2652
(337) 981-9182
Mailing address
106 STABLE CREEK DR, LAFAYETTE, LA 70506-5021
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
08545
LA
Other
Enumeration date
04/18/2017
Last updated
04/18/2017
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