Provider Demographics
NPI:1073694519
Name:ABBEY, WALTER LAWRENCE (RPT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:LAWRENCE
Last Name:ABBEY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 MARGARET LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5212
Mailing Address - Country:US
Mailing Address - Phone:530-273-7500
Mailing Address - Fax:530-273-7551
Practice Address - Street 1:104 MARGARET LN
Practice Address - Street 2:SUITE B
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-273-7500
Practice Address - Fax:530-273-7551
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT67590OtherREGISTERED PHYSICAL THERA
CA00PT67590OtherREGISTERED PHYSICAL THERA