| NPI | 1326576794 |
|---|---|
| Doing Business As | ERIC WALLACE |
| Entity Type | Organization |
| Authorized Contact | ERIC T WALLACE Owner/Physical Therapist 920-540-2344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11251-24) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WI 11251-24) |
| 2251S0007X Physical Therapist, Sports (Licence: WI 11251-24) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WI 11251-24) | |
| 225XP0019X Occupational Therapist, Physical Rehabilitation | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-07-21 |