Individual
MRS. DIANE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RKT
Contact information
Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(817) 385-5949
Mailing address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
Taxonomy
Speciality
Code
Description
License number
State
226300000X
Kinesiotherapist
Primary
1383
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1383
COPSKT
—
Enumeration date
07/26/2006
Last updated
10/09/2014
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