Individual
MR. ROBERT WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT, NASM
Contact information
Practice address
10651 WILSHIRE AVE NE, ALBUQUERQUE, NM 87122-3160
(307) 766-2323
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
590
NM
Other
Enumeration date
01/11/2011
Last updated
08/07/2025
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