Individual
ERIN WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
283 NW MILLER AVE, GRESHAM, OR 97030-7260
(503) 666-7644
(503) 674-9980
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
61718
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500723506
—
OR
01
—
R194481
MEDICARE
OR
01
—
R194482
MEDICARE
OR
01
—
R194483
MEDICARE
OR
01
—
R194484
MEDICARE
OR
01
—
R194485
MEDICARE
OR
01
—
R194486
MEDICARE
OR
Enumeration date
05/20/2016
Last updated
06/13/2017
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