Provider Demographics
NPI:1831429638
Name:WAL-INTEREST LLC
Entity type:Organization
Organization Name:WAL-INTEREST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-774-4343
Mailing Address - Street 1:3001 WILDFLOWER DR
Mailing Address - Street 2:SUITE 611
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3061
Mailing Address - Country:US
Mailing Address - Phone:979-774-4343
Mailing Address - Fax:
Practice Address - Street 1:3001 WILDFLOWER DR
Practice Address - Street 2:SUITE 611
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3061
Practice Address - Country:US
Practice Address - Phone:979-774-4343
Practice Address - Fax:509-315-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty