Individual
MRS. LINDA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1330 GRAND POINTE CT, GRAND BLANC, MI 48439-5502
(248) 674-9292
Mailing address
5601 HATCHERY RD, WATERFORD, MI 48329-3451
(248) 674-9292
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004025
MI
225200000X
Physical Therapy Assistant
—
MI
Other
Enumeration date
02/13/2014
Last updated
02/19/2021
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