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Organization
PRIS,PLC
Active
Organization
PRIS,PLC
Active
Other names
Brenda Waller , MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDA SUE WALLER MD (CEO)
(434) 528-0896
Entity
Organization
Contact information
Practice address
2600 MEMORIAL AVE, SUITE 201B, LYNCHBURG, VA 24501-2662
(434) 528-0896
(434) 528-0898
Mailing address
2600 MEMORIAL AVE, SUITE 201B, LYNCHBURG, VA 24501-2662
(434) 528-0896
(434) 528-0898
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0101055485
VA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
0101055485
VA
Other
Enumeration date
06/16/2009
Last updated
01/20/2011
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