Individual
MS. MALA JEAN WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2200 FORT ROOTS DR, N LITTLE ROCK, AR 72114-1709
(501) 257-1046
Mailing address
2200 FORT ROOTS DRIVE, N LITTLE ROCK, AR 72214
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
336
AR
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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