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Contact Information

JUDY L WALLIS, PTA
MARYWOOD HEALTH CENTER
111 LAKESIDE DRIVE NE
GRAND RAPIDS, MI49503
 Phone: 616-453-7715
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapy Assistant

225200000X
Indicates primary specialty

NPI Profile & details for JUDY L WALLIS · (Female)

NPI Number 1356558324
Status Active
Credentials PTA (Physical Therapist Assistant)
Entity Individual
Enumeration date 05/17/2007
Last updated 12/07/2018 - About 7 years ago
Sole proprietor 1 Yes
Identifiers
  • MI License # 5502000688
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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