Courtney Brooke Wallace, PT
Contractor in Raleigh, NC. Individual provider (NPI-1).
NPI number1285877217
StatusActive
Last updated in NPPESJan 22, 2021
Details
- NPI
- 1285877217
- Entity type
- Individual (NPI-1)
- Name
- Courtney Brooke Wallace
- Credential
- PT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 6, 2009
- Certification date
- Jan 22, 2021
- Last updated
- Jan 22, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | 8974 | NC | Yes |
Practice location
3601 Windemere PlRaleigh, NC 27604-5961
Phone 919-601-0149
Mailing address
9802 Carvel CtRaleigh, NC 27613-5754
Phone 984-200-2415
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