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Individual

MR. CODY LEE WALLS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC, LAT, EMT

Contact information

Practice address
4001 SUMMERHILL RD, TEXARKANA, TX 75503-2764
(903) 794-3891
Mailing address
4001 SUMMERHILL RD, TEXARKANA, TX 75503-2764
(903) 794-3891

Taxonomy

Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
168141
TX
146N00000X
Basic Emergency Medical Technician
22756
AR
174H00000X
Health Educator
1634643
TX
2255A2300X
Athletic Trainer
Primary
AT4598
TX

Other

Enumeration date
10/19/2012
Last updated
10/19/2012
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