Provider Demographics
NPI:1538553722
Name:WALLS, JOSHUA QUINCY
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:QUINCY
Last Name:WALLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5263 EMERSON VILLAGE LN
Mailing Address - Street 2:APT 106
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8001
Mailing Address - Country:US
Mailing Address - Phone:817-694-3171
Mailing Address - Fax:
Practice Address - Street 1:5263 EMERSON VILLAGE LN
Practice Address - Street 2:APT 106
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8001
Practice Address - Country:US
Practice Address - Phone:817-694-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program