Provider Demographics
NPI:1215159835
Name:WALTERS, JULIANNA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:JULIANNA
Middle Name:MARIE
Last Name:WALTERS
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 1:1281 OLD HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-1583
Mailing Address - Country:US
Mailing Address - Phone:936-639-1428
Mailing Address - Fax:
Practice Address - Street 1:2414 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3521
Practice Address - Country:US
Practice Address - Phone:639-699-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158703225100000X
PAPT016229225100000X
WVPT002327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist