Provider Demographics
NPI:1750512976
Name:WALTERS, JENNIFER RAE (LPTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JENKINS MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692
Mailing Address - Country:US
Mailing Address - Phone:740-384-2119
Mailing Address - Fax:
Practice Address - Street 1:142 JENKINS MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-9561
Practice Address - Country:US
Practice Address - Phone:740-384-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA5506225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant