Provider Demographics
NPI:1447922414
Name:WALSTON, KATHERYN LANAE
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:LANAE
Last Name:WALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N US HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5708
Mailing Address - Country:US
Mailing Address - Phone:830-992-2830
Mailing Address - Fax:
Practice Address - Street 1:1015 LAZY CREEK LN
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-4318
Practice Address - Country:US
Practice Address - Phone:210-249-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant