| NPI | 1255702304 |
|---|---|
| Former Name | STACEY A WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC p18973) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208216) |
| 225100000X Physical Therapist (Licence: SC 9834) | |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2025-05-28 |