Provider Demographics
NPI:1477846020
Name:WALLACE, PATRICK ALBERT II (ATP)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ALBERT
Last Name:WALLACE
Suffix:II
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4801 READING ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6716
Mailing Address - Country:US
Mailing Address - Phone:214-658-9091
Mailing Address - Fax:214-658-9051
Practice Address - Street 1:4801 READING ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-6716
Practice Address - Country:US
Practice Address - Phone:214-658-9091
Practice Address - Fax:214-658-9051
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other