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Individual

DR. TIFFANY DAWN WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
701 PLATINUM PT, LAKE MARY, FL 32746-4871
(407) 206-4500
(407) 643-2802
Mailing address
701 PLATINUM PT, LAKE MARY, FL 32746-4871
(407) 206-4500
(407) 643-2802

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
24764
FL
2251X0800X
Orthopedic Physical Therapist
Primary
PT24764
FL

Other

Enumeration date
06/29/2009
Last updated
04/12/2022
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