| Doctor Name: | MAUREEN V WALLACE |
| NPI Number: | 1396761995 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPT |
| License Number: | 1931PT |
| Business Practice Address: | 2430 N. 7th Unit 2 Bozeman, MT - 59715 |
| Business Phone Number: | 4065862772 |
| Business Fax Number: | 4065862644 |
| Mailing Address: | 4739 Meadow Lane, BOZEMAN |
| State: | MT |
| Postal Code: | 59715 |
| Phone Number: | 4065862772 |
| Fax Number: | 4065862644 |
| NPI Enumeration Date: | 07/15/2006 |
| NPI Last Update Date: | 11/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1931PT |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MT |
| 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 |