Individual
MELISSA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
161 CACTUS CT, LOUISVILLE, KY 40229-3109
(502) 510-6747
Mailing address
161 CACTUS CT, LOUISVILLE, KY 40229-3109
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
3806
KY
Other
Enumeration date
04/18/2011
Last updated
04/18/2011
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