Individual
DAVID WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
507 S ORANGE ST, NEW SMYRNA BEACH, FL 32168-7318
(386) 424-5293
Mailing address
3216 VICTORY PALM DR, EDGEWATER, FL 32141-6512
(386) 423-2158
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA0001464
FL
Other
Enumeration date
12/12/2007
Last updated
12/12/2007
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