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General NPI Number Information
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NPI Number | 1164756508
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Entity Type | Organization
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Legal Business Name | WALK OF LIFE
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 1027 HOLLOW CREEK DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-5534
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Country | US
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Telephone | 214-505-0270
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Fax | 972-293-6333
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Provider Business Mailing Address
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Address Line | 1027 HOLLOW CREEK DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-5534
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Country | US
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Telephone | 214-505-0270
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Fax | 972-293-6333
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Authorized Official
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Title or Position | DME PROVIDER
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Name | MR. JOHN BERRY
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Credential |
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Telephone | 214-505-0270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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