Provider Demographics
NPI:1689940215
Name:WALTERS, MARLENE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 PROSPECT AVE
Mailing Address - Street 2:P10X
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-3604
Mailing Address - Country:US
Mailing Address - Phone:914-434-4370
Mailing Address - Fax:718-364-5457
Practice Address - Street 1:2050 PROSPECT AVE
Practice Address - Street 2:P10X
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-3604
Practice Address - Country:US
Practice Address - Phone:718-329-4678
Practice Address - Fax:718-364-5457
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist