Individual
MR. MICHAEL DWAYNE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA, ATC, PTA, CEAS
Contact information
Practice address
7557 DANNAHER WAY, SUITE 230, POWELL, TN 37849-3558
(865) 938-5222
(865) 938-5264
Mailing address
217 JOHN BOULDIN DR, MARYVILLE, TN 37801-1902
(865) 898-2356
(865) 938-5264
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
3396
TN
2255A2300X
Athletic Trainer
110102223
TN
363A00000X
Physician Assistant
Primary
PENDING
TN
Other
Enumeration date
01/10/2007
Last updated
06/14/2010
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