Scott R Wallace
Physical Therapist in Sacramento, CA. Individual provider (NPI-1).
NPI number1982775615
StatusActive
Last updated in NPPESDec 30, 2021
Details
- NPI
- 1982775615
- Entity type
- Individual (NPI-1)
- Name
- Scott R Wallace
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 13, 2006
- Last updated
- Dec 30, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 26235 | CA | Yes |
Practice location
1650 Response RdSacramento, CA 95815-4807
Phone 916-614-4256
Mailing address
1650 Response RdSacramento, CA 95815-4807
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