| Addison Walter, | |
| 
					1288 W Main St Ste 148, Lewisville, TX 75067-3468  | |
| (469) 496-3992 | |
| (972) 845-7419 | 
| Full Name | Addison Walter | 
|---|---|
| Gender | Male | 
| Speciality | Physical Therapist | 
| Location | 1288 W Main St Ste 148, Lewisville, Texas | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1265170005 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 225100000X | Physical Therapist | 3128421 (Texas) | Primary | 
| Provider Name | Ideal Physical Therapy Of Texas Llc | 
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice | 
| Provider Identifiers | NPI Number: 1538573746 PECOS PAC ID: 0547583809 Enrollment ID: O20141218000890  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Addison Walter, 790 Remington Blvd, Bolingbrook, IL 60440-4909 Ph: (866) 370-8206  | Addison Walter, 1288 W Main St Ste 148, Lewisville, TX 75067-3468 Ph: (469) 496-3992  | 
Cathy Faye Ruelas, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 401 N Valley Pkwy, Ste 300, Lewisville, TX 75067 Phone: 972-353-5437  | |
Mrs. Cindy Dorazio Goetz, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 966 N Garden Ridge, Suite 530, Lewisville, TX 75077 Phone: 972-420-6605 Fax: 972-436-2770  | |
Namrata Prakash Keswani, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 1301 Justin Rd Ste 206, Lewisville, TX 75077 Phone: 972-317-7775  | |
Mr. William M Herritage Ii, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 724 W Main, Ste 180, Lewisville, TX 75067 Phone: 972-434-6024 Fax: 972-434-2784  | |
Ajay Agrawal,  Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 316 Wiltshire Blvd, Lewisville, TX 75056 Phone: 760-532-7808  | |
Lauren Deems, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2500 Sir Wade Way, Lewisville, TX 75056 Phone: 214-213-0899  | |
Mr. Scott Frederick Mcgough, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 724 W Main St Ste 180, Lewisville, TX 75067 Phone: 972-434-6024 Fax: 972-434-2784  |