Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 10604-24 | WI |
NPI | 1093262578 |
---|---|
Provider Name | Cathy Walls |
First Address | Wauwatosa, WI 53225-4813 |
Second Address | Milwaukee, WI 53201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |