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General NPI Number Information
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NPI Number | 1609564236
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Entity Type | Individual
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Provider Name | ETHAN WALKER
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Gender | Male
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 5755 CLEARFORK MAIN
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City | FORT WORTH
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State | TX
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Zip | 76109
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Country | US
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Telephone | 940-682-6805
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 MOUNTAIN MEADOW RD
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City | CROWLEY
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State | TX
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Zip | 76036-8554
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Country | US
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Telephone |
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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 | 1309772
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License Number State | TX
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