Individual
ANDREA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1231 PINE GROVE AVE, SUITE 1A, PORT HURON, MI 48060-3500
(810) 985-6300
Mailing address
1231 PINE GROVE AVE, SUITE 1A, PORT HURON, MI 48060-3500
(810) 985-6300
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501010425
MI
Other
Enumeration date
10/21/2010
Last updated
10/21/2010
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