Organization
CAROLINA PHYSICAL MEDICINE & REHABILITATION, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT BRUCE WALLACE M.D. (OWNER)
(704) 869-6699
Entity
Organization
Contact information
Practice address
1307 UNION RD, SUITE 105, GASTONIA, NC 28054-5562
(704) 869-6699
(704) 861-1996
Mailing address
1307 UNION RD, SUITE 105, GASTONIA, NC 28054-5562
(704) 869-6699
(704) 861-1996
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
23802
NC
Other
Enumeration date
09/28/2006
Last updated
07/13/2009
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