Individual
CONNOR THOMAS WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
564 HIGHWAY 133, LA FONTANA PLAZA, CARBONDALE, CO 81623
(970) 963-2700
Mailing address
907 VILLAGE RD, CARBONDALE, CO 81623-1567
(970) 618-2627
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0017394
CO
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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