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NPI Code Detail

MEDICARE: MELINDA I WALL PTA

MEDICARE: MELINDA I WALL PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1801229349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA I WALL PTA
Provider Business Mailing Address
First Line : 115 ACADEMY ST
Second Line :
City : DICKSON
State : TN
Zip : 37055-2013
Country : US
Telephone Number : 615-446-2085
Fax Number :
Provider Business Practice Location Address
First Line : 115 ACADEMY ST
Second Line :
City : DICKSON
State : TN
Zip : 37055-2013
Country : US
Telephone Number : 615-446-2085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2013
Last Update Date : 08/20/2013

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Directions to “ MELINDA I WALL PTA” Practice Location

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