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General NPI Number Information
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NPI Number | 1134124985
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Entity Type | Individual
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Provider Name | KEVIN LEE WALTERS PT
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 809 W HARWOOD RD STE 103
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City | HURST
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State | TX
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Zip | 76054-3289
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Country | US
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Telephone | 817-283-5252
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Fax | 817-283-5283
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Provider Business Mailing Address
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Address Line | 6101 FOREST RIVER DR
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City | FORT WORTH
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State | TX
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Zip | 76112-1066
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Country | US
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Telephone | 817-457-0077
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Fax | 817-457-8017
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1053353
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 1053353
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1053353
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License Number State | TX
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