Provider Demographics
NPI:1770875999
Name:WALTON, MARCUS (PTA)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:WALTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4424
Mailing Address - Country:US
Mailing Address - Phone:402-660-6067
Mailing Address - Fax:
Practice Address - Street 1:1900 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-4424
Practice Address - Country:US
Practice Address - Phone:402-660-6067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE975225200000X
FL22588225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant