| NPI | 1114422078 |
|---|---|
| Former Name | DANA JILL WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3952) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1143501) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-06-23 |