| Doctor Name: | MRS. LAURIE ANN WALLACE |
| NPI Number: | 1770704306 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPT, ATC |
| License Number: | PT18527 |
| Business Practice Address: | 438 Wisnom Ave San Mateo, CA - 944012422 |
| Business Phone Number: | 7723214992 |
| Business Fax Number: | |
| Mailing Address: | 438 Wisnom Ave, SAN MATEO |
| State: | CA |
| Postal Code: | 944012422 |
| Phone Number: | 7723214992 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2007 |
| NPI Last Update Date: | 10/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT18527 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| 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 |