Wallis, Jim Edward

Wallis, Jim Edward is an individual health care provider with primary practice located at 930 Sw Hall , Portland OR 97201. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as his primary health care specialty. Wallis, Jim Edward can be contacted via phone (503) 725-4073.

Contact Information

Primary practice address
930 Sw Hall Portland OR 97201
Phone: (503) 725-4073
Fax: (503) 725-5641
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X AT-AT-048672 Oregon

Profile Details

NPI number 1144283128
LBN Legal business name Wallis, Jim Edward
Credentials Athletic Trainer, Certified (ATC)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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