Individual
MISS DEANNA LOUISE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
500 GRAND PLAZA, ORANGE CITY, FL 32763
(386) 775-0855
(386) 775-0855
Mailing address
2341 EL PRADO TERRACE, DELTONA, FL 32763
(386) 747-0645
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA19131
FL
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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