Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTL 0012349 | CO |
NPI | 1003249855 |
---|---|
Provider Name | Dr. Julie Gilman Wallace |
First Address | Denver, CO 80218-1216 |
Second Address | Denver, CO 80218-1216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2013 |
Last Update Date | 15/08/2013 |