Provider Demographics
NPI:1801367107
Name:TERA WALTERS THERAPY LLC
Entity type:Organization
Organization Name:TERA WALTERS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:251-680-9686
Mailing Address - Street 1:148 RIDGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-2838
Mailing Address - Country:US
Mailing Address - Phone:251-680-9686
Mailing Address - Fax:
Practice Address - Street 1:110 AMBER LN
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-8623
Practice Address - Country:US
Practice Address - Phone:251-680-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-12
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty