Wallace, Jennifer L

Wallace, Jennifer L is an individual health care provider with primary practice located at 3891 50Th Ave S , Saint Petersburg FL 33711-4811. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Wallace, Jennifer L can be contacted via phone (630) 554-4701.

Contact Information

Primary practice address
3891 50Th Ave S Saint Petersburg FL 33711-4811
Phone: (630) 554-4701
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 22282 Florida
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 070.009079 Illinois

Profile Details

NPI number 1306035431
LBN Legal business name Wallace, Jennifer L
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 15th, 2007
Last updated May 3rd, 2010 - about 15 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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