Individual
MS. MANDY L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSRPT
Contact information
Practice address
121 E CEDAR ST, FLORENCE, SC 29506-2576
(843) 661-3426
(843) 661-3599
Mailing address
1465 NORWOOD RD, OLANTA, SC 29114-9533
(843) 687-2068
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4051
SC
Other
Enumeration date
03/08/2012
Last updated
03/08/2012
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