Provider Demographics
NPI:1710695432
Name:WALTERS, HEATHER LEE (LPTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7482 TOWNSHIP ROAD 32
Mailing Address - Street 2:
Mailing Address - City:JENERA
Mailing Address - State:OH
Mailing Address - Zip Code:45841-8915
Mailing Address - Country:US
Mailing Address - Phone:419-420-5417
Mailing Address - Fax:
Practice Address - Street 1:7482 TOWNSHIP ROAD 32
Practice Address - Street 2:
Practice Address - City:JENERA
Practice Address - State:OH
Practice Address - Zip Code:45841-8915
Practice Address - Country:US
Practice Address - Phone:419-420-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07364225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRT326022OtherDRIVER'S LICENSE