MRS. Misty W Wallace, PT

NPI #1174761951 in Yadkinville, North Carolina

Provider Information

NPI Number: 1174761951
Entity Type: Individual
Name: MRS. Misty W Wallace, PT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Credential: PT
Enumeration Date: Feb 2, 2009
Last Updated: Feb 2, 2009

Practice Location

Address: 903 W MAIN ST
City: Yadkinville
State: North Carolina
ZIP Code: 27055-7807
Phone: (336) 679-8863

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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