Most Relevant Information
Provider Data
| NPI Number: | 1003330945 |
| Provider Name: | JILLYN WALL LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | MT122402 |
Most Important Dates
| Enumeration Date: | 08/02/2017 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
1495 GARDEN OF THE GODS RD # 10
COLORADO SPRINGS
CO
809079441
Practice Location Phone/Fax
| Phone: | 7192609797 |
| Fax: |
Provider Mailing Location
1495 GARDEN OF THE GODS RD # 10
COLORADO SPRINGS
CO
809079441
Provider Mailing Phone/Fax
| Phone: | 7192609797 |
| Fax: |