Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501011412 | MI |
N | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1265939664 |
---|---|
Provider Name | Theresa Walter |
First Address | Midland, MI 48640-2690 |
Second Address | Clare, MI 48617-1145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2018 |
Last Update Date | 24/02/2021 |