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 |