IndividualActive
Michelle Wallace, PT
NPI 1477808947 · Pediatric Rehabilitation Medicine Physician · Tenafly, NJ
Provider details
- NPI number
- 1477808947
- Entity type
- Individual
- Primary specialty
- Pediatric Rehabilitation Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- PT
- Sex
- Female
- Sole proprietor
- Yes
- License
- 40QA00591600 (NJ)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
75 Norman Pl
Tenafly, NJ 07670-2537
Phone: (732) 761-0088
Approximate (ZIP-level) locationGet directions
Mailing address
75 Norman Pl
Tenafly, NJ 07670-2537
Registry dates
- Enumerated
- 2012-07-19
- Last updated
- 2012-07-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.