Provider Demographics
NPI:1841332111
Name:WALTER, DEANNA M (MPT)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:M
Last Name:WALTER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1089
Mailing Address - Country:US
Mailing Address - Phone:618-789-6978
Mailing Address - Fax:
Practice Address - Street 1:56 WORTHINGTON ACCESS DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3806
Practice Address - Country:US
Practice Address - Phone:314-439-0800
Practice Address - Fax:314-439-0801
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1144182251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics