Provider Demographics
NPI:1588647234
Name:WALTERS, ANN-MARIE ELIZABETH (PT 007663)
Entity Type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:ELIZABETH
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PT 007663
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 STOCKSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-5507
Mailing Address - Country:US
Mailing Address - Phone:937-644-3311
Mailing Address - Fax:937-644-0373
Practice Address - Street 1:211 STOCKSDALE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5507
Practice Address - Country:US
Practice Address - Phone:937-644-3311
Practice Address - Fax:937-644-0373
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.T. 007663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311356625027OtherCARESOURCE MCO
OH15668OtherNATIONWIDE INSURANCE
OH685840OtherUHC
OH2614504Medicaid
OH000000372029OtherANTHEM PROVIDER NUMBER
OH11460837OtherCAQH CREDENTIALING NUMBER
OH9401996OtherPHCS NETWORK
OHWA4160931Medicare PIN