Individual
MR. WALLACE EDGAR CRESSWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1855 HILL DR, GRENADA, MS 38901-5003
(662) 809-3339
Mailing address
934 SYCAMORE ST, GRENADA, MS 38901-5522
(662) 809-3339
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0438
MS
Other
Enumeration date
06/09/2011
Last updated
06/09/2011
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