Theresa Wallace, Owner
Home Health Aide in Riviera Beach, FL. Individual provider (NPI-1).
NPI number1013498039
StatusActive
Last updated in NPPESAug 27, 2018
Details
- NPI
- 1013498039
- Entity type
- Individual (NPI-1)
- Name
- Ms. Theresa Wallace
- Credential
- Owner
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 27, 2018
- Last updated
- Aug 27, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 374U00000X | Home Health Aide | – | FL | Yes |
Practice location
1200 Ac Evans St Apt 2Riviera Beach, FL 33404-2063
Phone 561-634-6091 · Fax 561-828-2343
Mailing address
1200 Ac Evans St Apt 2Riviera Beach, FL 33404-2063
Phone 561-634-6091 · Fax 561-828-2343
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