The holder whose full name is Wallace, Derek Bradley,come from Newburgh IN,hold the Phys Ther Assistant license(NO.06001705A) which status is Active.
| Name | Wallace, Derek Bradley |
|---|---|
| License Number | 06001705A |
| License Type | Phys Ther Assistant |
| License Status | Active |
| City | Newburgh |
| State | IN |