Jessica Wallace

NPI #1760206460 in La Plata, Maryland

Provider Information

NPI Number: 1760206460
Entity Type: Individual
Name: Jessica Wallace
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Enumeration Date: Nov 11, 2024
Last Updated: Nov 11, 2024

Practice Location

Address: 101 CENTENNIAL ST STE C
City: La Plata
State: Maryland
ZIP Code: 20646-5976
Phone: (301) 392-3700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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