MEDICARE: JENNA WALTER PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8693	SC

General Provider Information

NPI Number	:	1770720351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA WALTER PT, DPT

Provider Business Mailing Address
First Line	:	2171 SENECA RIDGE DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4178
Country	:	US
Telephone Number	:	239-233-5240
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 SENECA RIDGE DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4178
Country	:	US
Telephone Number	:	239-233-5240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/28/2026

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