Individual
CHRISTOPHER WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
130 HACIENDA, INDIALANTIC, FL 32903-2835
(321) 456-7883
Mailing address
130 HACIENDA, INDIALANTIC, FL 32903-2835
(321) 456-7883
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA30410
FL
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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