Provider Demographics
NPI:1952352270
Name:WALTERS, ROBERT B (CO/CPED)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:WALTERS
Suffix:
Gender:M
Credentials:CO/CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 SUNSET RIDGE RD
Mailing Address - Street 2:STE103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6667
Mailing Address - Country:US
Mailing Address - Phone:919-789-8222
Mailing Address - Fax:919-789-8226
Practice Address - Street 1:3909 SUNSET RIDGE RD
Practice Address - Street 2:STE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6667
Practice Address - Country:US
Practice Address - Phone:919-789-8222
Practice Address - Fax:919-789-8226
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3923222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCO003923OtherABC