| Doctor Name: | DAVID R WALLACE |
| NPI Number: | 1760626576 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT2738 |
| Business Practice Address: | 2170 S Lamar Blvd Oxford, MS - 386555224 |
| Business Phone Number: | 6622348559 |
| Business Fax Number: | 6622347923 |
| Mailing Address: | 2170 S. Lamar Blvd, OXFORD |
| State: | MS |
| Postal Code: | 38655 |
| Phone Number: | 6622348559 |
| Fax Number: | 6622347923 |
| NPI Enumeration Date: | 04/23/2009 |
| NPI Last Update Date: | 04/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT2738 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| 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 |