Provider Demographics
NPI:1770180259
Name:WALLS, MARSHALL DAVID (ATC)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:DAVID
Last Name:WALLS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 NEEDLE PALM WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3547
Mailing Address - Country:US
Mailing Address - Phone:850-284-8774
Mailing Address - Fax:
Practice Address - Street 1:3000 SCHOOL HOUSE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7855
Practice Address - Country:US
Practice Address - Phone:850-284-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00007942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty