Provider Demographics
NPI:1932299336
Name:WALLS, CATHERINE M (PT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:WALLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6147
Mailing Address - Country:US
Mailing Address - Phone:617-923-0757
Mailing Address - Fax:617-923-2127
Practice Address - Street 1:521 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4191
Practice Address - Country:US
Practice Address - Phone:617-923-0757
Practice Address - Fax:617-923-2127
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67797OtherBC/BS
MAY68608Medicare ID - Type Unspecified