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Contact Information

KENNETH WALLACE, PTA
170 COREY RD
BRIGHTON HOUSE REHABILITATION AND NURSING CENTER
BRIGHTON, MA02135
 Phone: 617-731-0515
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapy Assistant

225200000X
Indicates primary specialty

NPI Profile & details for KENNETH WALLACE · (Male)

NPI # 1952787533
Status Active
Credentials PTA (Physical Therapist Assistant)
Entity Individual
Enumeration date 08/05/2015
Last updated 08/05/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • MA License # 8869
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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