Provider Demographics
NPI:1215092598
Name:MCWALTER, ANN (PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MCWALTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1132
Mailing Address - Country:US
Mailing Address - Phone:781-487-3800
Mailing Address - Fax:781-487-3801
Practice Address - Street 1:40 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1132
Practice Address - Country:US
Practice Address - Phone:781-487-3800
Practice Address - Fax:781-487-3801
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0314609Medicaid
650023025Medicare PIN
MAY68281Medicare PIN