Provider Demographics
NPI:1124492509
Name:WALDEN, MATTHEW ZACHARY (PT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ZACHARY
Last Name:WALDEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N A W GRIMES BLVD
Mailing Address - Street 2:APT 512
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3421
Mailing Address - Country:US
Mailing Address - Phone:817-821-0604
Mailing Address - Fax:
Practice Address - Street 1:2000 S MAYS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7531
Practice Address - Country:US
Practice Address - Phone:512-244-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1231871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist