Individual
ANDRE LAMAR WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
435 W ROOSEVELT BLVD APT 2, PHILADELPHIA, PA 19120-4148
(215) 435-5560
Mailing address
435 W ROOSEVELT BLVD APT 2, PHILADELPHIA, PA 19120-4148
(215) 435-5560
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MSG007581
PA
Other
Enumeration date
09/13/2020
Last updated
09/13/2020
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