MEDICARE: MR. CHAD A WALTERS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1150108	TX
2	363AM0700X	Medical Physician Assistant
3	363AM0700X	Medical Physician Assistant	PA13380	TX

General Provider Information

NPI Number	:	1467459396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD A WALTERS PA-C

Provider Business Mailing Address
First Line	:	1309 HICKORY ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-3509
Country	:	US
Telephone Number	:	325-480-9280
Fax Number	:	325-673-0856

Provider Business Practice Location Address
First Line	:	1309 HICKORY ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-3509
Country	:	US
Telephone Number	:	325-480-9280
Fax Number	:	325-673-0856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/30/2024

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