Provider Demographics
NPI:1801200449
Name:WALTER, BRYCE (LAT, AT-C)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:WALTER
Suffix:
Gender:M
Credentials:LAT, AT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 W KELLOGG ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1100
Mailing Address - Country:US
Mailing Address - Phone:316-440-1100
Mailing Address - Fax:316-440-1089
Practice Address - Street 1:12112 W KELLOGG ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1100
Practice Address - Country:US
Practice Address - Phone:316-440-1100
Practice Address - Fax:316-440-1089
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-006952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer