Healthcare Provider Details

I. General information

NPI: 1427109263
Provider Name (Legal Business Name): COLETTE MARY WALL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8070 PARK LN STE 130
DALLAS TX
75231-6439
US

IV. Provider business mailing address

8070 PARK LN STE 130
DALLAS TX
75231-6439
US

V. Phone/Fax

Practice location:
  • Phone: 469-372-0021
  • Fax: 469-372-0021
Mailing address:
  • Phone: 469-372-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1325024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: