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Individual

MRS. AIMEE JENNIFER WALLACE

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
MSPT

Contact information

Practice address
711 S COWLEY ST, SPOKANE, WA 99202-1330
(509) 473-6000
(509) 473-6097
Mailing address
1202 S LACEY ST, SPOKANE, WA 99202-4355

Taxonomy

Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
Primary
PT00008674
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PT00008674
PT LICENSE
WA
Enumeration date
04/12/2006
Last updated
07/08/2007
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