Individual
MRS. BETHANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1416 CHURCHVILLE AVE, SUITE A, STAUNTON, VA 24401-1718
(540) 213-0345
Mailing address
1416 CHURCHVILLE AVE, SUITE A, STAUNTON, VA 24401
(540) 213-0345
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305005759
VA
Other
Enumeration date
07/15/2008
Last updated
07/15/2008
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