Individual
ANDRE WALLS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
974 47TH ST APT D3, BROOKLYN, NY 11219-2808
(347) 398-7981
Mailing address
974 47TH ST APT D3, BROOKLYN, NY 11219-2808
(347) 398-7981
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
024063
NY
Other
Enumeration date
11/27/2012
Last updated
11/27/2012
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