Provider Demographics
NPI:1083691323
Name:SHULL, WALTER G JR (PT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:G
Last Name:SHULL
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4646 CORONA DR
Mailing Address - Street 2:STE 130
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-225-2539
Mailing Address - Fax:361-225-0851
Practice Address - Street 1:4646 CORONA DR
Practice Address - Street 2:STE 130
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-225-2539
Practice Address - Fax:361-225-0851
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT182006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y24392Medicare UPIN
TX8D1926Medicare ID - Type Unspecified
00240YMedicare UPIN