Individual
MRS. JUDY LYNN WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
MARYWOOD HEALTH CENTER, 111 LAKESIDE DRIVE NE, GRAND RAPIDS, MI 49503
(616) 453-7715
Mailing address
8572 MCARTHUR AVE NE, GREENVILLE, MI 48838-8372
(616) 481-4235
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
5502000688
MI
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
05/17/2007
Last updated
12/07/2018
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