Provider Demographics
NPI:1760826119
Name:WALTHER, RONALD MATHIAS SR (LMP)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MATHIAS
Last Name:WALTHER
Suffix:SR
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8908 N WHEAT CREST LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-5046
Mailing Address - Country:US
Mailing Address - Phone:509-280-1517
Mailing Address - Fax:
Practice Address - Street 1:8908 N WHEAT CREST LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-5046
Practice Address - Country:US
Practice Address - Phone:509-280-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-27
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60315707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist