National Provider Identifier
Georgiana Wallace
Georgiana Wallace is listed in the NPPES registry with a primary specialty of Athletic Trainer in Ithaca, NY and a listed phone number of (240) 429-6986.
Profile Overview
- NPI
- 1427929843
- Provider Type
- Individual
- Primary Specialty
- Athletic Trainer
- Enumeration Date
- September 17, 2025
- Last Updated
- September 17, 2025
Practice Location
- 953 Danby RD
- Ithaca, NY 14850-7002
Phone: (240) 429-6986
Specialties
- Athletic Trainer (2255A2300X)
Full Record
- NPI
- 1427929843
- Entity Type
- Individual
- Last Name
- Wallace
- First Name
- Georgiana
- Mailing Street Address
- 953 Danby RD
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-7002
- Mailing Country
- US
- Mailing Phone
- (240) 429-6986
- Practice Street Address
- 953 Danby RD
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-7002
- Practice Country
- US
- Practice Phone
- (240) 429-6986
- Enumeration Date
- September 17, 2025
- Last Updated
- September 17, 2025
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- September 17, 2025
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Athletic Trainer (2255A2300X)