MEDICARE: ABIGAIL ROSE WALTER PT, DPT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	61176725	WA

General Provider Information

NPI Number	:	1467931170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ROSE WALTER PT, DPT, ATC

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 S 12TH ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-2540
Country	:	US
Telephone Number	:	253-336-2040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	02/03/2022

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