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Individual

JESSICA WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
101 CENTENNIAL ST STE C, LA PLATA, MD 20646-5976
(301) 392-3700
Mailing address
1911 S 21ST ST, ROGERS, AR 72758-6101
(479) 270-0588

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary

Other

Enumeration date
11/11/2024
Last updated
11/11/2024
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