Basic Information
| Provider Information | |||||||||
| NPI: | 1568624575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALTERS | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31710 JIM DAVIS RD | ||||||||
| Address2: | |||||||||
| City: | GALENA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216351417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886485750 | ||||||||
| FaxNumber: | 4106485751 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 MORGNEC RD | ||||||||
| Address2: | |||||||||
| City: | CHESTERTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216201046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107781900 | ||||||||
| FaxNumber: | 4107786301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 06/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 19835 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | J1-0001332 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.