| NPI | 1801521356 |
|---|---|
| Former Name | CECELIA ELIZABETH WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH CP014782T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215153) |
| 225100000X Physical Therapist (Licence: OH PT019956) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2023-01-18 |