Amanda Waller

NPI #1134504657 in Rice Lake, Wisconsin

Provider Information

NPI Number: 1134504657
Entity Type: Individual
Name: Amanda Waller
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Jul 26, 2015
Last Updated: Jul 26, 2015

Practice Location

Address: 19 W NEWTON ST
City: Rice Lake
State: Wisconsin
ZIP Code: 54868-1744
Phone: (715) 234-2161

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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