Provider Demographics
NPI:1508921669
Name:WALTNER, GREGORY A (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:WALTNER
Suffix:
Gender:M
Credentials:MS, ATC
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 1231
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1231
Mailing Address - Country:US
Mailing Address - Phone:541-285-6766
Mailing Address - Fax:
Practice Address - Street 1:OF INTERCOLLEGIATE ATHLETICS
Practice Address - Street 2:ICA BUILDING
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-5200
Practice Address - Country:US
Practice Address - Phone:805-893-3424
Practice Address - Fax:805-893-5420
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist