Individual
SHANE WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 PROVIDENT DR, WARSAW, IN 46580-3252
(574) 371-2779
Mailing address
2069 E WADE RD, WARSAW, IN 46580-7697
(574) 453-1844
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004508A
IN
Other
Enumeration date
04/17/2014
Last updated
04/24/2014
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