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General NPI Number Information
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NPI Number | 1114676129
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Entity Type | Individual
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Provider Name | DEBRA ANNETTE WALTON PTA
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Gender | Female
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 151 ROYAL DR
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City | HEWITT
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State | TX
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Zip | 76643-2959
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Country | US
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Telephone | 254-420-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 7582 SPRING VALLEY RD
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City | MOODY
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State | TX
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Zip | 76557-4133
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Country | US
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Telephone | 254-744-7425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2009890
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License Number State | TX
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