Provider Demographics
NPI:1922524982
Name:WALTERS, JOCELYN CELESTINE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:CELESTINE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GILMORE AVE APT 234
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-1804
Mailing Address - Country:US
Mailing Address - Phone:904-955-5993
Mailing Address - Fax:
Practice Address - Street 1:1000 LONGFELLOW BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6034
Practice Address - Country:US
Practice Address - Phone:863-667-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL48832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer