Individual
JOSEPH R. WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
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
Update your record
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