Individual
GARY WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1031 W WILLIAMS ST STE 104, APEX, NC 27502-3955
(919) 267-5284
(888) 635-6138
Mailing address
3708 FORESTVIEW RD STE 105, RALEIGH, NC 27612-2391
(919) 977-9727
(888) 635-6138
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO04318
—
224P00000X
Prosthetist
Primary
CPO04318
—
Other
Enumeration date
07/01/2019
Last updated
07/01/2019
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