Provider Demographics
NPI:1225160161
Name:WALTERS, VICKI LYNN (PT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:108 SWEDESBORO ROAD, SUITE 10
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-0503
Mailing Address - Country:US
Mailing Address - Phone:856-223-8898
Mailing Address - Fax:856-223-8799
Practice Address - Street 1:108 SWEDESBORO RD STE 10
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1800
Practice Address - Country:US
Practice Address - Phone:856-223-8898
Practice Address - Fax:856-223-8799
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025632M6CMedicare ID - Type Unspecified