Provider Demographics
NPI:1033652367
Name:WALTHER, KEVIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:WALTHER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5176 CANADICE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:NY
Mailing Address - Zip Code:14466
Mailing Address - Country:US
Mailing Address - Phone:585-278-6458
Mailing Address - Fax:
Practice Address - Street 1:3506 THOMAS DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9730
Practice Address - Country:US
Practice Address - Phone:585-346-0060
Practice Address - Fax:585-346-0108
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist