Provider Demographics
NPI:1114065638
Name:WALTERS, JOHN (MS, AT, ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 WESTBANK RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3174
Mailing Address - Country:US
Mailing Address - Phone:419-708-8298
Mailing Address - Fax:
Practice Address - Street 1:2346 WESTBANK RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3174
Practice Address - Country:US
Practice Address - Phone:419-708-8298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0035752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer