Individual
MR. WALLACE WILLIAM PERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
111 BREWSTER ST, PAWTUCKET, RI 02860-4400
(401) 729-2629
Mailing address
144 CENTRE ST, RUMFORD, RI 02916-3146
(401) 438-5031
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA00091
RI
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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