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SHANNON WALLACE

>> Physical Therapy Assistant >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1437707452

Individual Registrant:
 SHANNON  WALLACE 
Gender: F
Not Sole Proprietor

Location and contact information for practice:
3108 CIRCLE DR  WHITE PINE, TN 37890-3306 US
Tel: 865-674-7454  Fax: --

Contact information for business:
PO BOX 150  LIMA, OH 45802-0150 US
Tel: --  Fax: --

Registration Information:
NPI: 1437707452
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225200000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapy Assistant
TN7143

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS TN - Page 1



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