Individual
MRS. DEBORAH ELAINE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
5147 SPRING ST, SYLVANIA, OH 43560-2832
(419) 882-0427
Mailing address
5147 SPRING ST, SYLVANIA, OH 43560-2832
(419) 882-0427
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-2606
OH
Other
Enumeration date
11/28/2012
Last updated
11/28/2012
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