Provider Demographics
NPI:1457360430
Name:WALTERS, CAROL
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 SCHROBACK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:CT
Mailing Address - Zip Code:06782-2003
Mailing Address - Country:US
Mailing Address - Phone:860-584-9834
Mailing Address - Fax:
Practice Address - Street 1:22 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1417
Practice Address - Country:US
Practice Address - Phone:203-419-0381
Practice Address - Fax:203-419-0389
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist