Individual
MICHAEL L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2351 INDIAN WELLS, ALAMOGORDO, NM 88310-5012
(575) 439-1397
(575) 437-2622
Mailing address
PO BOX 2860, ALAMOGORDO, NM 88311-2860
(575) 439-1397
(575) 437-2622
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1953
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65579844
—
NM
01
—
NM00Q164
BLUE CROSS BLUE SHIELD
NM
Enumeration date
08/26/2005
Last updated
06/21/2011
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us