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Individual

EVAN ARIEL WALTERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
104 MAGARET LANE, GRASS VALLEY, CA 95945
(530) 263-8006
(530) 273-7551
Mailing address
10435 EAST DR, GRASS VALLEY, CA 95945-8502
(530) 273-2850

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
294652
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
294652
PHYSICAL THERAPIST
CA
05
294652
CA
Enumeration date
05/18/2018
Last updated
05/18/2018
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