Individual
MARA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 ROBERT ST N UNIT 606, SAINT PAUL, MN 55101-4456
(612) 581-0468
Mailing address
500 ROBERT ST N UNIT 606, SAINT PAUL, MN 55101-4456
(612) 581-0468
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A1906
MN
Other
Enumeration date
07/07/2015
Last updated
07/07/2015
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