Provider Demographics
NPI:1154375103
Name:WALTERS, DANIEL J (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:WALTERS
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 1:3451 PHEASANT MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7324
Mailing Address - Country:US
Mailing Address - Phone:636-379-0092
Mailing Address - Fax:636-978-8299
Practice Address - Street 1:3451 PHEASANT MEADOW DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7324
Practice Address - Country:US
Practice Address - Phone:636-379-0092
Practice Address - Fax:636-978-8299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000145657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist