Individual
MRS. JUDY DENISE WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4425 S CAMILLE ST, SALT LAKE CITY, UT 84124-3624
(954) 336-4183
Mailing address
4425 S CAMILLE ST, SALT LAKE CITY, UT 84124-3624
(954) 336-4183
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8398928-2402
UT
Other
Enumeration date
06/20/2014
Last updated
06/20/2014
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