Individual
MRS. KATHRYN SUSAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
112 VIOLA AVE, OSHKOSH, WI 54901-1973
(920) 424-0170
Mailing address
3109 QUAIL RUN DR, OSHKOSH, WI 54904-6597
(724) 713-1964
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12894-24
WI
225100000X
Physical Therapist
Primary
PA016454
PA
Other
Enumeration date
10/25/2006
Last updated
05/26/2026
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