Individual
DIANA WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27 W FRONT ST, LOGAN, OH 43138-1825
(740) 974-4515
Mailing address
27 W FRONT ST, LOGAN, OH 43138-1825
(740) 974-4515
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
33.004623N-R
OH
Other
Enumeration date
12/08/2014
Last updated
12/08/2014
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