MEDICARE: REBECA LYNN WALTERS LMT

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	225700000X	Massage Therapist	MT131185	TX

General Provider Information

NPI Number	:	1528655248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECA LYNN WALTERS LMT

Provider Business Mailing Address
First Line	:	1816 9TH ST
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-4717
Country	:	US
Telephone Number	:	325-261-9012
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 EARLY BLVD STE 2D
Second Line	:
City	:	EARLY
State	:	TX
Zip	:	76802-2208
Country	:	US
Telephone Number	:	325-261-9012
Fax Number	:

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

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	12/29/2020

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