Individual
GRACE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
550 MUNSON AVE, TRAVERSE CITY, MI 49686-3580
(231) 935-8659
Mailing address
1105 6TH ST, TRAVERSE CITY, MI 49684-2345
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501018654
MI
Other
Enumeration date
12/03/2018
Last updated
02/25/2022
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