Individual
TIMOTHY E WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.
Contact information
Practice address
1325 SAN MARCO BLVD, #102, JACKSONVILLE, FL 32207-8568
(904) 858-7045
(904) 858-7047
Mailing address
1325 SAN MARCO BLVD, SUITE 701, JACKSONVILLE, FL 32207-8568
(904) 858-6418
(904) 858-6490
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL351
FL
Other
Enumeration date
07/25/2006
Last updated
07/08/2007
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