Most Relevant Information
Provider Data
| NPI Number: | 1003442773 |
| Provider Name: | VICKI LYNNE WALTER PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 2032191 |
Most Important Dates
| Enumeration Date: | 03/13/2020 |
| Last Updated: | 03/13/2020 |
Provider Practice Location
701 OLYMPIC PLAZA CIR
TYLER
TX
757011950
Practice Location Phone/Fax
| Phone: | 9035963119 |
| Fax: | 9035963122 |
Provider Mailing Location
4231 STONEBROOK LN
TYLER
TX
757075475
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |