Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2032191 | TX |
NPI | 1003442773 |
---|---|
Provider Name | Vicki Lynne Walter |
First Address | Tyler, TX 75707-5475 |
Second Address | Tyler, TX 75701-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2020 |
Last Update Date | 13/03/2020 |