Individual
WALLACE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
701 SESAME ST, SUITE 101, ANCHORAGE, AK 99503-6647
(907) 561-2260
Mailing address
701 SESAME ST, SUITE 101, ANCHORAGE, AK 99503-6647
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1625
AK
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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