Provider Demographics
NPI:1568624575
Name:WALTERS, BRIAN H (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:H
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31710 JIM DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:MD
Mailing Address - Zip Code:21635-1417
Mailing Address - Country:US
Mailing Address - Phone:888-648-5750
Mailing Address - Fax:410-648-5751
Practice Address - Street 1:415 MORGNEC RD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1046
Practice Address - Country:US
Practice Address - Phone:410-778-1900
Practice Address - Fax:410-778-6301
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19835225100000X
DEJ1-0001332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist