Healthcare Provider Details

I. General information

NPI: 1043298425
Provider Name (Legal Business Name): WALLACE MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 STONERIDGE LANE
DUBLIN OH
43017
US

IV. Provider business mailing address

16600 SPRAGUE ROAD SUITE 365
MIDDLEBURG HEIGHTS OH
44130
US

V. Phone/Fax

Practice location:
  • Phone: 614-504-4733
  • Fax: 440-498-9725
Mailing address:
  • Phone: 216-227-7700
  • Fax: 866-848-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARSHA A ZATCOFF
Title or Position: DIRECTOR
Credential:
Phone: 864-244-3626