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General NPI Number Information
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NPI Number | 1326638289
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Entity Type | Organization
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Legal Business Name | WALL WORKS PT LLC
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Dates
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Enumeration Date | 01/24/2021
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 7420 4TH AVE S
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City | RICHFIELD
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State | MN
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Zip | 55423
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Country | US
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Telephone | 641-521-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 3992 133RD CT W
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City | ROSEMOUNT
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State | MN
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Zip | 55068
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Country | US
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Telephone | 612-568-2462
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Fax | 612-429-4568
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MICHELLE M WALL
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Credential | PT, DPT
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Telephone | 641-521-4590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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