Individual
MR. ISAAC GALEN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMBT
Contact information
Practice address
3326 CHAPEL DR # 230, DURHAM, NC 27708-9964
(919) 251-8437
Mailing address
3326 CHAPEL DR # 230, DURHAM, NC 27708-9964
(919) 251-8437
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9478
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9478
MASSAGE LICENSE
NC
Enumeration date
02/05/2007
Last updated
07/21/2019
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