Provider Demographics
NPI:1407094022
Name:SALLY WALTER, LLC
Entity Type:Organization
Organization Name:SALLY WALTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:512-470-4023
Mailing Address - Street 1:4729 TELLO PATH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1135
Mailing Address - Country:US
Mailing Address - Phone:512-470-4023
Mailing Address - Fax:512-291-0368
Practice Address - Street 1:4729 TELLO PATH
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1135
Practice Address - Country:US
Practice Address - Phone:512-470-4023
Practice Address - Fax:512-291-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00311246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty