Individual
MR. GARY WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
6220 1 AND A HALF HALF MILE ROAD, STERLING HEIGHTS, MI 48314
(586) 731-6603
(586) 731-1148
Mailing address
13781 IRONWOOD DR, SHELBY TOWNSHIP, MI 48315-4226
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/15/2007
Last updated
07/08/2007
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