| Doctor Name: | JENNIFER MARIE WALLACE |
| NPI Number: | 1205855921 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.T. |
| License Number: | PT27874 |
| Business Practice Address: | 1929 Main St 103 Irvine, CA - 926140509 |
| Business Phone Number: | 9497979007 |
| Business Fax Number: | 9497979224 |
| Mailing Address: | 1929 Main St, 103 IRVINE |
| State: | CA |
| Postal Code: | 926140509 |
| Phone Number: | 9497979007 |
| Fax Number: | 9497979224 |
| NPI Enumeration Date: | 07/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT27874 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |