Wallace, Gary Robert

Wallace, Gary Robert is an individual health care provider with primary practice located at 13 Northtown Dr Trinity Rehab Suite 110, Jackson MS 39211. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as his primary health care specialty. Wallace, Gary Robert can be contacted via phone (601) 206-9195.

Contact Information

Primary practice address
13 Northtown Dr Trinity Rehab Suite 110 Jackson MS 39211
Phone: (601) 206-9195
Fax: (601) 957-8391
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X A2636 Louisiana

Profile Details

NPI number 1003009184
LBN Legal business name Wallace, Gary Robert
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2007
Last updated Aug 22nd, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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