Provider Demographics
NPI:1033820816
Name:WALL THERAPY SOLUTIONS LLC
Entity Type:Organization
Organization Name:WALL THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-882-8847
Mailing Address - Street 1:19104 CANYON CREEK PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3148
Mailing Address - Country:US
Mailing Address - Phone:405-882-8847
Mailing Address - Fax:405-708-6095
Practice Address - Street 1:19104 CANYON CREEK PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-3148
Practice Address - Country:US
Practice Address - Phone:405-882-8847
Practice Address - Fax:405-708-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty