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General NPI Number Information
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NPI Number | 1164493474
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Entity Type | Individual
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Provider Name | CRISTINE A. WALTERS MPT
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Gender | Female
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 512 MAIN ST
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City | ASHTON
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State | ID
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Zip | 83420-5026
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Country | US
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Telephone | 208-652-9979
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Fax | 208-372-0609
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Provider Business Mailing Address
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Address Line | PO BOX 553
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City | ASHTON
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State | ID
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Zip | 83420-0553
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Country | US
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Telephone | 208-313-3735
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Fax | 208-372-0609
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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 | RPT-1604
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License Number State | ID
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