Provider Demographics
NPI:1710003157
Name:WALTERS, JOSEPH BRUCE (MS PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRUCE
Last Name:WALTERS
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Gender:M
Credentials:MS PT
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Mailing Address - Street 1:5581 BOBWHITE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-4593
Mailing Address - Country:US
Mailing Address - Phone:269-375-3404
Mailing Address - Fax:269-323-4300
Practice Address - Street 1:1423 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5351
Practice Address - Country:US
Practice Address - Phone:269-323-4300
Practice Address - Fax:269-323-4449
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI55010082302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic