Provider Demographics
NPI:1295365120
Name:WALTERS, SCOTT R (CPED)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:R
Last Name:WALTERS
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:KENDALL
Mailing Address - State:NY
Mailing Address - Zip Code:14476-9776
Mailing Address - Country:US
Mailing Address - Phone:810-730-1942
Mailing Address - Fax:
Practice Address - Street 1:3385 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2813
Practice Address - Country:US
Practice Address - Phone:585-473-5950
Practice Address - Fax:585-473-9596
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist