Individual
TAFFY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12211 N PARADISE VILLAGE PKWY S APT 105, PHOENIX, AZ 85032-7630
(310) 743-4183
Mailing address
111 E DUNLAP AVE # 1148, PHOENIX, AZ 85020-2807
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT23493
AZ
Other
Enumeration date
12/22/2020
Last updated
12/22/2020
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