Provider Demographics
NPI:1740721711
Name:WALTER, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 S LAKE DR
Mailing Address - Street 2:STE 90-125
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6824
Mailing Address - Country:US
Mailing Address - Phone:585-943-3980
Mailing Address - Fax:
Practice Address - Street 1:1792 S LAKE DR
Practice Address - Street 2:STE 90-125
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-6824
Practice Address - Country:US
Practice Address - Phone:585-943-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010342-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist