Individual
MR. MATTHEW LYLE WALKER
Active
Individual
MR. MATTHEW LYLE WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT
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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