Jordeen Wallace

NPI #1093856007 in West Plains, Missouri

Provider Information

NPI Number: 1093856007
Entity Type: Individual
Name: Jordeen Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Feb 11, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1100 N KENTUCKY AVE
City: West Plains
State: Missouri
ZIP Code: 65775-2029
Phone: (417) 257-5959

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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