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General NPI Number Information
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NPI Number | 1235044488
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Entity Type | Individual
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Provider Name | TIMI WALLACE PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 08/14/2026
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Last Update Date | 08/14/2026
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Provider Practice Location Address
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Address Line | 30 BRIGHAM ST
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City | NEW BEDFORD
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State | MA
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Zip | 02740-2206
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Country | US
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Telephone | 774-770-4903
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Fax |
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Provider Business Mailing Address
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Address Line | 14 KLONDIKE ST
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City | PROVIDENCE
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State | RI
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Zip | 02909-5517
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Country | US
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Telephone | 401-390-1653
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL89428
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License Number State | MA
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