Individual
WALTER CARELL III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1245 CHARNELTON ST STE 7, EUGENE, OR 97401-6206
(541) 554-2730
Mailing address
4200 BERRYWOOD DR, EUGENE, OR 97404-7001
(541) 554-2730
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
20737
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20737
MASSAGE THERAPIST
OR
Enumeration date
08/28/2014
Last updated
02/24/2021
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