Provider Demographics
NPI:1578646139
Name:WALTON, W. TODD (PT)
Entity Type:Individual
Prefix:MR
First Name:W.
Middle Name:TODD
Last Name:WALTON
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 1:18122 SW LOWER BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7216
Mailing Address - Country:US
Mailing Address - Phone:503-639-2118
Mailing Address - Fax:503-639-7688
Practice Address - Street 1:18122 SW LOWER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7216
Practice Address - Country:US
Practice Address - Phone:503-639-2118
Practice Address - Fax:503-639-7688
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109629Medicare PIN