Provider Demographics
NPI:1336187012
Name:KOLD, WALTER (PT)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:KOLD
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 1:5N201 SHADY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-8557
Mailing Address - Country:US
Mailing Address - Phone:630-584-2254
Mailing Address - Fax:
Practice Address - Street 1:411 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6335
Practice Address - Country:US
Practice Address - Phone:847-854-9754
Practice Address - Fax:847-658-8185
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic