Individual provider · Type 1 NPI

Michell Wallace, PTA

Physical Therapy Assistant · Trumbull, CT

NPI number 1043554413 Active

Practice location

6448 Main St
Trumbull, CT 06611-2075

Mailing address

2810 Old Town Rd
Bridgeport, CT 06606-1243

Specialties and licenses

TaxonomyCodeLicense
Physical Therapy Assistant Primary 225200000X000988 (CT)

Physical Therapy Assistant: (1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the U.S. Department of Education or Council on Postsecondary Accreditation, who assists the physical therapist in providing physical therapy. The supervising physical therapist is directly responsible for the actions of …

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About NPI 1043554413

Michell Wallace, PTA's National Provider Identifier is 1043554413, issued on Nov 24, 2012. The primary taxonomy on file is Physical Therapy Assistant (225200000X), and the practice location is in Trumbull, CT. The record was last updated on Nov 24, 2012.