Provider Demographics
NPI:1922400704
Name:WALSTON, ZACHARY E (DPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:E
Last Name:WALSTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242278
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2278
Mailing Address - Country:US
Mailing Address - Phone:334-396-3273
Mailing Address - Fax:334-396-4905
Practice Address - Street 1:4849 S COBB DR SE
Practice Address - Street 2:SUITE 121
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7145
Practice Address - Country:US
Practice Address - Phone:866-464-3878
Practice Address - Fax:334-396-4905
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist