Provider Demographics
NPI:1962479501
Name:WALTS, SUSAN E (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:WALTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:14100 CARLSON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-5312
Practice Address - Country:US
Practice Address - Phone:763-519-7900
Practice Address - Fax:763-450-0202
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN7419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist