Provider Demographics
NPI:1699284489
Name:WALTER, SAMUEL STEVEN (DPT)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:STEVEN
Last Name:WALTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:3114 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-3609
Mailing Address - Country:US
Mailing Address - Phone:515-943-2719
Mailing Address - Fax:
Practice Address - Street 1:55 CENTRAL IOWA DR
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4705
Practice Address - Country:US
Practice Address - Phone:641-754-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist