Individual
ELLEN DEANNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
404 CEDAR CT, WINCHESTER, KY 40391-2923
(859) 737-5888
Mailing address
404 CEDAR CT, WINCHESTER, KY 40391-2923
(859) 737-5888
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003834
KY
Other
Enumeration date
07/08/2008
Last updated
07/08/2008
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