Provider Demographics
NPI:1013353135
Name:WALTHER, THOMAS RAY JR (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RAY
Last Name:WALTHER
Suffix:JR
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 1:4101 TATES CREEK CENTRE DR STE 144
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3068
Mailing Address - Country:US
Mailing Address - Phone:859-271-2887
Mailing Address - Fax:
Practice Address - Street 1:4101 TATES CREEK CENTRE DR STE 144
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3068
Practice Address - Country:US
Practice Address - Phone:859-271-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist