Individual
MR. MATTHEW LYLE WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
2321 E GALA ST, SUITE 1, MERIDIAN, ID 83642-4881
(208) 888-4321
(208) 895-8747
Mailing address
2321 E GALA ST, SUITE 1, MERIDIAN, ID 83642-4881
(208) 888-4321
(208) 895-8747
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1718
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148919
REGENCE
ID
01
—
TA914
BLUE CROSS OF IDAHO PROV
ID
Enumeration date
07/12/2006
Last updated
07/09/2007
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