Individual
TEGAN WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
722 S 8TH ST, CANON CITY, CO 81212-4906
(719) 345-4097
Mailing address
722 S 8TH ST, CANON CITY, CO 81212-4906
(719) 345-4097
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA0013440
CO
Other
Enumeration date
02/15/2016
Last updated
02/15/2016
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