Provider Demographics
NPI:1669490108
Name:GAINEY, WALTER CALVIN (AT,C, SCAT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:CALVIN
Last Name:GAINEY
Suffix:
Gender:M
Credentials:AT,C, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 PINE DALE CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-9508
Mailing Address - Country:US
Mailing Address - Phone:803-981-1326
Mailing Address - Fax:803-981-1322
Practice Address - Street 1:320 W SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-8567
Practice Address - Country:US
Practice Address - Phone:803-981-1326
Practice Address - Fax:803-981-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer