JIM EDWARD WALLIS

PORTLAND, OR
NPI1144283128
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: OR  at-at-048672)
Enumeration Date2006-04-10
Last Update Date2024-12-29
Business Address
Mr. JIM EDWARD WALLIS ATC
930 SW HALL
PORTLAND, OR 97201
Phone number: 503-725-4073
Mailing Address
Mr. JIM EDWARD WALLIS ATC
6209 NE 24TH AVE
PORTLAND, OR 97211-6005
Phone number: 503-284-8629