MR. Khalil Rashaun Wallace

NPI #1528516580 in Fairchild Afb, Washington

Provider Information

NPI Number: 1528516580
Entity Type: Individual
Name: MR. Khalil Rashaun Wallace
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Sep 19, 2016
Last Updated: Sep 19, 2016

Practice Location

Address: 7275 NEBRASKA AVE
City: Fairchild Afb
State: Washington
ZIP Code: 99011-3001
Phone: (786) 512-1492

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist/Technologist - Athletic Trainer — Athletic Trainer	2255A2300X
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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