Doctor Name: | RYAN JAMES WALLACE |
NPI Number: | 1568420354 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT, DPT, OCS, MTC |
License Number: | PT 18604 |
Business Practice Address: | 25241 Elementary Way Ste 200 Bonita Springs, FL - 341357883 |
Business Phone Number: | 2399474184 |
Business Fax Number: | 2399474171 |
Mailing Address: | 8079 Breton Cir, FORT MYERS |
State: | FL |
Postal Code: | 339124651 |
Phone Number: | 2399474184 |
Fax Number: | 2399474181 |
NPI Enumeration Date: | 05/02/2006 |
NPI Last Update Date: | 05/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT 18604 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
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 |