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General NPI Number Information
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NPI Number | 1326163494
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Entity Type | Individual
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Provider Name | CHARLES EDWARD WALDING DPT
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1015 W. 39TH & HALF ST.
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City | AUSTIN
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State | TX
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Zip | 78756-4005
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Country | US
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Telephone | 512-371-7478
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Fax |
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Provider Business Mailing Address
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Address Line | 10050 GREAT HILLS TRL APT 1330
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City | AUSTIN
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State | TX
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Zip | 78759-5860
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Country | US
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Telephone | 214-546-2020
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1173123
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License Number State | TX
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