Amanda Lynn Wallace, PTA

NPI #1417539388 in Halethorpe, Maryland

Provider Information

NPI Number: 1417539388
Entity Type: Individual
Name: Amanda Lynn Wallace, PTA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Apr 21, 2021
Last Updated: Apr 21, 2021

Practice Location

Address: 1908 WOODSIDE AVE
City: Halethorpe
State: Maryland
ZIP Code: 21227-4547
Phone: (410) 430-7257

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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