Provider Demographics
NPI:1396109906
Name:WALTERS, CATHY A (ATC, LAT, CSCS)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:WALTERS
Suffix:
Gender:F
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:A
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT, CSCS
Mailing Address - Street 1:10827 VEGA VISTA DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:505-250-3959
Mailing Address - Fax:
Practice Address - Street 1:532 OSUNA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113
Practice Address - Country:US
Practice Address - Phone:505-250-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer