Provider Demographics
NPI:1639266554
Name:WALTERS, TAMMY PRIDGEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:PRIDGEN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COVESHIRE PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3150
Mailing Address - Country:US
Mailing Address - Phone:256-682-0616
Mailing Address - Fax:
Practice Address - Street 1:230 HUGHES RD STE F
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1113
Practice Address - Country:US
Practice Address - Phone:256-682-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist