Healthcare Provider Details

I. General information

NPI: 1952826893
Provider Name (Legal Business Name): JOSHUA WALTERS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2017
Last Update Date: 08/02/2021
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 E BROAD ST STE 111
MANSFIELD TX
76063-6425
US

IV. Provider business mailing address

4020 SHAGBARK ST
FORT WORTH TX
76137-1430
US

V. Phone/Fax

Practice location:
  • Phone: 817-435-5248
  • Fax: 817-435-5249
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1325094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: