Provider Demographics
NPI:1316270382
Name:WALTERS, JOSHUA (LMP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 BROADWAY ST
Mailing Address - Street 2:SUITE # B
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3390
Mailing Address - Country:US
Mailing Address - Phone:360-693-2112
Mailing Address - Fax:360-735-9058
Practice Address - Street 1:2031 BROADWAY ST
Practice Address - Street 2:SUITE # B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3390
Practice Address - Country:US
Practice Address - Phone:360-693-2112
Practice Address - Fax:360-735-9058
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60055709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist