Provider Demographics
NPI:1770720351
Name:WALTER, JENNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:POSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 S KINGS DR STE JJ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3088
Mailing Address - Country:US
Mailing Address - Phone:704-242-1490
Mailing Address - Fax:
Practice Address - Street 1:601 S KINGS DR STE JJ
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3088
Practice Address - Country:US
Practice Address - Phone:704-242-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13329OtherNORTH CAROLINA BOARD OF PHYSICAL THERAPY