Individual
CALEB WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3030 RANDOLPH RD STE 105A, CHARLOTTE, NC 28211-1365
(704) 512-4420
Mailing address
12313 E PALERMO CT, FORT MILL, SC 29707-6483
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P24590
NC
Other
Enumeration date
12/29/2025
Last updated
12/29/2025
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