Provider Demographics
NPI:1467472043
Name:WALTER, ANITA S (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:S
Last Name:WALTER
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 1:23-22 30TH RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3238
Mailing Address - Country:US
Mailing Address - Phone:718-726-2627
Mailing Address - Fax:718-726-2627
Practice Address - Street 1:23-22 30TH RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3238
Practice Address - Country:US
Practice Address - Phone:718-726-2627
Practice Address - Fax:718-726-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013668-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14308623OtherMULTI PLAN PT
NY02739811Medicaid
NY02739811Medicaid