NPI 1003009184

Gary Robert Wallace, PTA

Practitioner Physical Therapy Assistant Jackson, MS

Practice location

Address: 13 Northtown Dr Trinity Rehab Suite 110, Jackson, MS 39211
Phone: (601) 206-9195
Fax: (601) 957-8391
Mailing address: 13 Northtown Dr Suite 110 Trinity Rehab, Jackson, MS 39211

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence A2636 (LA)

Other Physical Therapy Assistant providers in Mississippi →

Registry record

NPI: 1003009184
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Aug 2007
Record last updated: 22 Aug 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.