Provider Demographics
NPI:1831185784
Name:MADY, WALTER (PT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:MADY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 DORSEY HALL DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7766
Mailing Address - Country:US
Mailing Address - Phone:410-730-9851
Mailing Address - Fax:410-730-9855
Practice Address - Street 1:4801 DORSEY HALL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7766
Practice Address - Country:US
Practice Address - Phone:410-730-9851
Practice Address - Fax:410-730-9855
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD153402251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6545-0003OtherBLUE CHOICE
MD236397OtherMAMSI
MD6545-0003OtherBLUE CHOICE