Individual
DAVID R WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2170 S LAMAR BLVD, OXFORD, MS 38655-5224
(662) 234-8559
(662) 234-7923
Mailing address
2170 S. LAMAR BLVD, OXFORD, MS 38655
(662) 234-8559
(662) 234-7923
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2738
MS
Other
Enumeration date
04/23/2009
Last updated
04/23/2009
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