Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT34293 | CA |
Y | 2251G0304X | Physical Therapist - Geriatrics | PT60108407 | WA |
NPI | 1326221391 |
---|---|
Provider Name | Kirsten Lee Walters |
First Address | Bremerton, WA 98312-3639 |
Second Address | Bremerton, WA 98312-3639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 22/12/2009 |