Individual
MR. MELVIN WALLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
8166 MAIN ST, HOUMA, LA 70360-3404
(985) 873-4141
Mailing address
8166 MAIN ST, HOUMA, LA 70360-3404
(985) 873-4141
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.200141
LA
Other
Enumeration date
12/23/2021
Last updated
12/23/2021
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