Provider Demographics
NPI:1619377579
Name:CARELL, WALTER III (LMT)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:CARELL
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 BERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-7001
Mailing Address - Country:US
Mailing Address - Phone:541-554-2730
Mailing Address - Fax:
Practice Address - Street 1:1245 CHARNELTON ST STE 7
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6206
Practice Address - Country:US
Practice Address - Phone:541-554-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20737172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20737OtherMASSAGE THERAPIST