Individual
SHYANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1150 HARVEST DR, LEBANON, PA 17046-1574
(717) 376-9110
Mailing address
1150 HARVEST DR, LEBANON, PA 17046-1574
(717) 376-9110
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RTO000512
PA
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
12/06/2019
Last updated
01/11/2021
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