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NPI Code Detail

MEDICARE: CORINNE ELIZABETH WALLIS PT, DPT

MEDICARE: CORINNE ELIZABETH WALLIS PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistLPT-32671AZ

General Provider Information

NPI Number : 1255040358
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORINNE ELIZABETH WALLIS PT, DPT
Provider Business Mailing Address
First Line : 3500 N SABINO CANYON RD UNIT 90
Second Line :
City : TUCSON
State : AZ
Zip : 85750-6167
Country : US
Telephone Number : 813-447-9647
Fax Number :
Provider Business Practice Location Address
First Line : 6011 N ORACLE RD STE 151
Second Line :
City : TUCSON
State : AZ
Zip : 85704-5309
Country : US
Telephone Number : 520-561-0101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2022
Last Update Date : 11/16/2022

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