Individual
MICHELLE M WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT/DPT, ATC
Contact information
Practice address
3992 133RD CT W, ROSEMOUNT, MN 55068-5338
(641) 521-4590
Mailing address
3992 133RD CT W, ROSEMOUNT, MN 55068-5338
(641) 521-4590
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10890
MN
2255A2300X
Athletic Trainer
074480
IA
Other
Enumeration date
07/07/2014
Last updated
10/31/2022
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