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General NPI Number Information
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NPI Number | 1467003822
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Entity Type | Individual
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Provider Name | SARAH JANE WALLEY MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 800 E MCNEESE STREET
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City | LAKE CHARLES
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State | LA
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Zip | 70607
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Country | US
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Telephone | 337-475-5219
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Fax |
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Provider Business Mailing Address
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Address Line | 6237 HAAG PL APT A
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City | FORT POLK
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State | LA
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Zip | 71459-3328
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Country | US
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Telephone | 601-347-0780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 320905
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License Number State | LA
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