Provider Demographics
NPI:1295873149
Name:WALTERS, AMY L (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 RED RIVER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 RED RIVER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2660
Practice Address - Country:US
Practice Address - Phone:512-476-8857
Practice Address - Fax:512-482-8199
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007914225100000X
TX11287832251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2241WAOtherBLUE SHIELD #
WAUS2596035OtherAETNA SPECIALIST PIN
WA0039585OtherLABOR AND INDUSTRIES #
WA8342685Medicaid
WAP00210388Medicare ID - Type UnspecifiedRAILROAD MC#
WA8342685Medicaid
8802710Medicare ID - Type Unspecified