Provider Demographics
NPI:1689356479
Name:WALL WELLNESS & ASSOCIATES
Entity Type:Organization
Organization Name:WALL WELLNESS & ASSOCIATES
Other - Org Name:WALL WELLNESS & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-247-0034
Mailing Address - Street 1:2500 NE GREEN OAKS BLVD STE 203B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-3028
Mailing Address - Country:US
Mailing Address - Phone:817-381-9362
Mailing Address - Fax:682-381-8673
Practice Address - Street 1:2500 NE GREEN OAKS BLVD STE 203B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-3028
Practice Address - Country:US
Practice Address - Phone:407-212-7113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty