| Organization Name: | WALLACE PHYSICAL THERAPY, PLLC |
| NPI Number: | 1992721450 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDI H WALLACE (PRESIDENT) |
| Mailing Address: | 59a James St Homer |
| State: | NY US |
| Postal Code: | 130771222 |
| Phone Number: | 3154164327 |
| Fax Number: | 6077495618 |
| NPI Enumeration Date: | 07/15/2006 |
| NPI Last Update Date: | 09/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 017462-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| 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 |