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General NPI Number Information
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NPI Number | 1831429638
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Entity Type | Organization
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Legal Business Name | WAL-INTEREST LLC
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 3001 WILDFLOWER DR SUITE 611
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City | BRYAN
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State | TX
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Zip | 77802-3061
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Country | US
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Telephone | 979-774-4343
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Fax | 509-315-8354
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Provider Business Mailing Address
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Address Line | 3001 WILDFLOWER DR SUITE 611
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City | BRYAN
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State | TX
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Zip | 77802-3061
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Country | US
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Telephone | 979-774-4343
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLIFF LATHAM
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Credential |
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Telephone | 979-774-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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