NPI 1043554413

Michell Wallace, PTA

Practitioner Physical Therapy Assistant Trumbull, CT

Practice location

Address: 6448 Main St, Trumbull, CT 06611-2075
Phone: (203) 268-6204
Mailing address: 2810 Old Town Rd, Bridgeport, CT 06606-1243

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence 000988 (CT)

Other Physical Therapy Assistant providers in Connecticut →

Registry record

NPI: 1043554413
Entity type: Individual
Sex (as registered): Female
NPI issued: 24 Nov 2012
Record last updated: 24 Nov 2012

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.