Individual
MARY WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1446 LAWRENCE ST, EUGENE, OR 97401-4592
(541) 683-3274
Mailing address
1446 LAWRENCE ST, EUGENE, OR 97401-4592
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1855
OR
225700000X
Massage Therapist
7197
OR
Other
Enumeration date
01/31/2008
Last updated
05/07/2009
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