| NPI | 1275526253 |
|---|---|
| Other Name | DOUG WALLOP |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 17006) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: MD 17006) |
| 2251S0007X Physical Therapist Sports (Licence: MD 17006) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: MD 17006) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2012-05-09 |