| Doctor Name: | MICHAEL L WALLACE |
| NPI Number: | 1578556312 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 1953 |
| Business Practice Address: | 2351 Indian Wells Alamogordo, NM - 883105012 |
| Business Phone Number: | 5754391397 |
| Business Fax Number: | 5754372622 |
| Mailing Address: | Po Box 2860, ALAMOGORDO |
| State: | NM |
| Postal Code: | 883112860 |
| Phone Number: | 5754391397 |
| Fax Number: | 5754372622 |
| NPI Enumeration Date: | 08/26/2005 |
| NPI Last Update Date: | 06/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1953 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| 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 |