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General NPI Number Information
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NPI Number | 1427407436
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Entity Type | Individual
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Provider Name | BYRON WALLACE ATP
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Gender | Male
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 8501 FORSYTHIA DR
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City | MCKINNEY
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State | TX
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Zip | 75070
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Country | US
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Telephone | 214-335-8632
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Fax |
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Provider Business Mailing Address
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Address Line | 8501 FORSYTHIA DR
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City | MCKINNEY
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State | TX
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Zip | 75070-6754
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Country | US
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Telephone | 214-394-0257
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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 | 225CA2400X
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Taxonomy Name | Assistive Technology Practitioner Rehabilitation Counselor
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License Number | 75739
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License Number State | TX
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