Provider Demographics
NPI:1710236427
Name:WALDEN, JANET NELSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:NELSON
Last Name:WALDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:LEE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2401 BERNADETTE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4672
Mailing Address - Country:US
Mailing Address - Phone:573-818-3474
Mailing Address - Fax:
Practice Address - Street 1:2401 BERNADETTE DR
Practice Address - Street 2:STE 202
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4672
Practice Address - Country:US
Practice Address - Phone:573-818-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist