Individual
MR. ALAN WILLIAM WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, CSCS, PES
Contact information
Practice address
2281 ANTIGUA DR, APT. 1C, COLUMBUS, OH 43235-6122
(412) 638-7071
Mailing address
2281 ANTIGUA DR, APT. 1C, COLUMBUS, OH 43235-6122
(412) 638-7071
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-4473
OH
Other
Enumeration date
12/03/2015
Last updated
12/03/2015
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