Provider Demographics
NPI:1427145093
Name:WALTERS, JUDITH DAWN
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:DAWN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 ST ANDREWS RD
Mailing Address - Street 2:STE D COLUMBIA REHABILITATION CLINIC
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4169
Mailing Address - Country:US
Mailing Address - Phone:803-772-2735
Mailing Address - Fax:803-798-5514
Practice Address - Street 1:4350 ST ANDREWS RD
Practice Address - Street 2:STE D COLUMBIA REHABILITATION CLINIC
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4169
Practice Address - Country:US
Practice Address - Phone:803-772-2735
Practice Address - Fax:803-798-5514
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5262208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation