Individual
LORRI WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3419 US 75 HWY, NEODESHA, KS 66757-9443
(620) 330-2748
Mailing address
3419 US 75 HWY, NEODESHA, KS 66757-9443
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-01984
KS
Other
Enumeration date
05/04/2017
Last updated
05/04/2017
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