Individual
KENNETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
170 COREY RD, BRIGHTON HOUSE REHABILITATION AND NURSING CENTER, BRIGHTON, MA 02135
(617) 731-0515
Mailing address
170 COREY RD, BRIGHTON HOUSE REHABILITATION AND NURSING CENTER, BRIGHTON, MA 02135
(617) 731-0515
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8869
MA
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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