THERESA A WALLACE

DAYTONA BEACH, FL
NPI1437404548
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: FL  PA9113017)
Additional Taxonomies2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: FL  AL2836)
Enumeration Date2012-07-16
Last Update Date2024-11-21
Business Address
THERESA A WALLACE PA-C, ATC
1865 LPGA BLVD
DAYTONA BEACH, FL 32117-7108
Phone number: 386-255-4596
Mailing Address
THERESA A WALLACE PA-C, ATC
1865 LPGA BLVD
DAYTONA BEACH, FL 32117-7108
Phone number: 386-255-4596