Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1053353 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1053353 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1053353 | TX |
NPI | 1134124985 |
---|---|
Provider Name | Mr. Kevin Lee Walters |
First Address | Fort Worth, TX 76112-1066 |
Second Address | Hurst, TX 76054-3289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 08/07/2007 |