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NPI Code Detail

MEDICARE: WALTER DWAIN WARE JR.

MEDICARE: WALTER DWAIN WARE JR.
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
1225200000XPhysical Therapy Assistant2140905TX

General Provider Information

NPI Number : 1912487174
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER DWAIN WARE JR.
Provider Business Mailing Address
First Line : 1329 WINDY MEADOWS DR
Second Line :
City : BURLESON
State : TX
Zip : 76028-2574
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4201 STONEGATE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-9503
Country : US
Telephone Number : 817-924-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2018
Last Update Date : 08/17/2018

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Directions to “ WALTER DWAIN WARE JR. ” Practice Location

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