Individual
ELLIS B WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2008 MOORE RD, MATTHEWS, NC 28105-4978
(877) 407-3422
(877) 407-4329
Mailing address
13545 KINTYRE CT, MATTHEWS, NC 28105-3032
(919) 449-7954
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P19348
NC
Other
Enumeration date
06/19/2020
Last updated
04/30/2025
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