Provider Demographics
NPI:1427472356
Name:WALTON, KIMBERLY (PTA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1725
Mailing Address - Country:US
Mailing Address - Phone:262-903-4508
Mailing Address - Fax:
Practice Address - Street 1:211 S PRINCE ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1725
Practice Address - Country:US
Practice Address - Phone:262-903-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2116-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant