Healthcare Provider Details

I. General information

NPI: 1457360430
Provider Name (Legal Business Name): MS. CAROL WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL PARKER

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 TOMPKINS ST
WATERBURY CT
06708-1417
US

IV. Provider business mailing address

165 SCHROBACK RD
PLYMOUTH CT
06782-2003
US

V. Phone/Fax

Practice location:
  • Phone: 203-419-0381
  • Fax: 203-419-0389
Mailing address:
  • Phone: 860-584-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005007
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: