Individual
MR. BRUCE ALLEN WALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
451 HEALTH PKWY, PAW PAW, MI 49079-8242
(269) 657-1490
(269) 657-1444
Mailing address
451 HEALTH PKWY, PAW PAW, MI 49079-8242
(269) 657-1490
(269) 657-1444
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501015692
MI
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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