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1760727283
KELLY WALLACE
SOUTHAVEN, MS
NPI
1760727283
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: MS 1734)
Enumeration Date
2012-12-10
Last Update Date
2012-12-10
Business Address
KELLY WALLACE PT
7160 TCHULAHOMA RD STE 4
SOUTHAVEN, MS 38671-9266
Phone number: 662-349-2733
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Mailing Address
KELLY WALLACE PT
7160 TCHULAHOMA RD STE 4
SOUTHAVEN, MS 38671-9266
Phone number:
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