Individual
MS. CRISTINE A. WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
512 MAIN ST, ASHTON, ID 83420-5026
(208) 652-9979
(208) 372-0609
Mailing address
PO BOX 553, ASHTON, ID 83420-0553
(208) 313-3735
(208) 372-0609
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT-1604
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010146459
REGENCE BLUE SHIELD
ID
05
—
8069260
—
ID
01
—
T8802
BLUE CROSS
ID
Enumeration date
01/27/2006
Last updated
03/20/2023
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