Individual
JENNIFER M WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
14575 NE 35TH STREET E104, BELLEVUE, WA 98007
(704) 962-5557
Mailing address
14575 NE 35TH STREET E104, BELLEVUE, WA 98007
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A1 60329486
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
WA
Enumeration date
05/03/2013
Last updated
05/03/2013
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