Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1073814547 |
---|---|
Provider Name | Mr. Anthony Brian Walls |
First Address | San Antonio, TX 78229-4404 |
Second Address | San Antonio, TX 78229-4404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2010 |
Last Update Date | 09/12/2010 |