| Organization Name: | BETHANN WALLACE |
| NPI Number: | 1396809125 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BETHANN WALLACE (OWNER) |
| Mailing Address: | 1416 Churchville Ave Suite A Staunton |
| State: | VA US |
| Postal Code: | 24401 |
| Phone Number: | 5402130345 |
| Fax Number: | 5408862609 |
| NPI Enumeration Date: | 12/19/2006 |
| NPI Last Update Date: | 07/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 235005465 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| 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 |