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Contact Information

SANDI H WALLACE, PT
59 A JAMES ST.
HOMER, NY13077
 Phone: 315-416-4327
 Fax: 866-550-6451
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for SANDI H WALLACE · (Female)

NPI Number 1255351813
Status Active
Credentials PT (Physical Therapist)
Entity Individual
Enumeration date 07/19/2006
Last updated 10/10/2008 - About 18 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 017462-1
  • NY Medicaid 02458611
  • NY Other 000158099 EXCELLUS
  • NY Other P00162216 MEDICARE RAILROAD
  • NY Other 364724 MVP
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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