Individual
CRYSTAL W WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
117 BO BO DR, CRYSTAL SPRINGS, MS 39059-2741
(601) 892-6330
(601) 892-6331
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(423) 206-4158
(717) 773-4654
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA5277
MS
Other
Enumeration date
11/03/2021
Last updated
11/03/2021
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