Individual
BRANDON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, PTA
Contact information
Practice address
250 US-377, SUITE 300, ARGYLE, TX 76226
(940) 489-1460
Mailing address
4003 BLOCK DR APT 1112, IRVING, TX 75038-8010
(903) 436-1880
(504) 349-6844
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1380704
TX
225200000X
Physical Therapy Assistant
2146592
TX
225200000X
Physical Therapy Assistant
A9272
LA
Other
Enumeration date
10/28/2015
Last updated
08/14/2023
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