Garrett Wallace

NPI #1306339262 in Summit, Mississippi

Provider Information

NPI Number: 1306339262
Entity Type: Individual
Name: Garrett Wallace
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Enumeration Date: Jun 14, 2018
Last Updated: Jun 14, 2018

Practice Location

Address: 4109 HIGHWAY 98 W
City: Summit
State: Mississippi
ZIP Code: 39666-9132
Phone: (601) 276-3909

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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