Provider Demographics
NPI:1508678228
Name:MCWALTERS, BRENDAN THOMAS
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:THOMAS
Last Name:MCWALTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11104 BOTHWELL ST
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2260
Mailing Address - Country:US
Mailing Address - Phone:804-852-1071
Mailing Address - Fax:
Practice Address - Street 1:11104 BOTHWELL ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-2260
Practice Address - Country:US
Practice Address - Phone:804-852-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer