Individual
REGINALD EUGENE WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6137 DUNROMING RD, BALTIMORE, MD 21239-1924
(443) 610-9579
Mailing address
6137 DUNROMING RD, BALTIMORE, MD 21239-1924
(443) 610-9579
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4439
MD
Other
Enumeration date
05/08/2016
Last updated
05/08/2016
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