Provider Demographics
NPI:1790818474
Name:WALTERS, AMY BETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:EXLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8045 SHANK HESS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-9250
Mailing Address - Country:US
Mailing Address - Phone:304-261-9668
Mailing Address - Fax:
Practice Address - Street 1:20009 ROSEBANK WAY
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6739
Practice Address - Country:US
Practice Address - Phone:240-420-1857
Practice Address - Fax:240-420-1859
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA 000996225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant