| NPI | 1184677544 |
|---|---|
| Former Name | AMBER MARIE WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: CA 23988) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 23988) |
| 2251N0400X Physical Therapist Neurology (Licence: CA 23988) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: CA 23988) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2015-01-06 |