Individual
MR. KEVIN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
307 N 5TH ST, MARYVILLE, TN 37804-2921
(865) 983-0261
Mailing address
307 N 5TH ST, MARYVILLE, TN 37804-2921
(865) 983-0261
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2300
TN
Other
Enumeration date
08/28/2008
Last updated
08/28/2008
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