Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1111946 | TX |
NPI | 1104338110 |
---|---|
Provider Name | Jennifer Walling |
First Address | Little Elm, TX 75068-5259 |
Second Address | Little Elm, TX 75068-5259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2017 |
Last Update Date | 31/10/2017 |