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Individual

JOSEPH R. WALLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
E3277 APPLE TREE LN, WAUPACA, WI 54981-7580
(715) 256-0358
(715) 256-0393
Mailing address
4000 N PROVIDENCE AVE, APPLETON, WI 54913-8018
(920) 257-2005
(920) 257-2004

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6231-024
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
27F99WA
BCBS OF MN
MN
05
40319100
WI
01
42B57WA
BCBS OF MN
MN
01
64-03552
MEDICA
WI
01
64-07247
MEDICA
WI
01
650023250
RAILROAD MEDICARE/POPLAR
WI
01
84251
SECURITY HEALTH PLAN
WI
01
P00403685
RAILROAD MEDICARE/NEW LONDON
WI
Enumeration date
06/16/2006
Last updated
06/27/2013
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