Kody Wallace
NPI #1912061607 in Mineral Wells, Texas
Provider Information
- NPI Number
- 1912061607
- Entity Type
- Individual
- Name
- Kody Wallace
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Physical Therapist
- Enumeration Date
- Dec 20, 2006
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 400 SW 25TH AVE
- City
- Mineral Wells
- State
- Texas
- ZIP Code
- 76067-8246
- Phone
- (940) 328-6580
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physical Therapist |
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