Dr. Colby Evan Wallace
Physical Therapist - Neurology
12 Executive Park Dr Ne
Atlanta
, Georgia 30329-2206
Dr. Colby Evan Wallace
Physical Therapist - Neurology
12 Executive Park Dr Ne
Atlanta
, Georgia 30329-2206
(615) 653-9596
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About
Features
Specialties
- Physical Therapist - Neurology
Languages spoken
- English
Location
First Address
- Dr. Colby Evan Wallace
- 7208 Northlake Heights Cir Ne
- Atlanta, GA
- Zip : 30345-2262
- Phone : (615) 653-9596
Second Address
- Dr. Colby Evan Wallace
- 12 Executive Park Dr Ne
- Atlanta, GA
- Zip : 30329-2206
- Phone : (404) 778-3444
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2251N0400X | Physical Therapist - Neurology | PT012499 | GA |
National Provider Identifier
| NPI | 1457806622 |
|---|---|
| Provider Name | Dr. Colby Evan Wallace |
| First Address | Atlanta, GA 30345-2262 |
| Second Address | Atlanta, GA 30329-2206 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/08/2016 |
| Last Update Date | 17/08/2016 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.