Individual
AMANDA WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 W NEWTON ST, RICE LAKE, WI 54868-1744
(715) 234-2161
Mailing address
19 W NEWTON ST, RICE LAKE, WI 54868-1744
(715) 234-2161
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2319-19
WI
Other
Enumeration date
07/26/2015
Last updated
07/26/2015
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