Individual
MR. LAWRENCE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PT
Contact information
Practice address
1021 2ND AVE N STE 6, NORTH MYRTLE BEACH, SC 29582-3200
(843) 286-5168
(844) 318-8980
Mailing address
1021 2ND AVE N STE 6, NORTH MYRTLE BEACH, SC 29582-3200
(843) 286-5168
(844) 318-8980
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101234728
VA
207X00000X
Orthopaedic Surgery Physician
MD439714
PA
225100000X
Physical Therapist
Primary
11194
SC
225100000X
Physical Therapist
P2177
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010114446
—
VA
Enumeration date
09/12/2005
Last updated
01/26/2026
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