Provider Demographics
NPI:1831319300
Name:WALTHER, ANTHONY LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LEE
Last Name:WALTHER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 DEER PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-9330
Mailing Address - Country:US
Mailing Address - Phone:503-589-8108
Mailing Address - Fax:503-315-2947
Practice Address - Street 1:5000 DEER PARK DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-9330
Practice Address - Country:US
Practice Address - Phone:503-589-8108
Practice Address - Fax:503-315-2947
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-10083122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer