Individual
MRS. KERRI ANNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
324 W 5TH ST, WASHINGTON, MO 63090-2306
(636) 239-7848
Mailing address
216 W MAIN ST, SULLIVAN, MO 63080-1911
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2008036904
MO
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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