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1396147047
HYACINTH WALLACE
CHICAGO, IL
NPI
1396147047
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: FL PT31379)
Enumeration Date
2014-09-24
Last Update Date
2018-06-14
Business Address
-- HYACINTH WALLACE P.T, DPT
4008 N CICERO AVE
CHICAGO, IL 60641-1807
Phone number: 773-481-0540
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Mailing Address
-- HYACINTH WALLACE P.T, DPT
105 MARINER HEALTH WAY STE 213
ST AUGUSTINE, FL 32086-3251
Phone number: 904-217-4259
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