Healthcare Provider Details

I. General information

NPI: 1912013335
Provider Name (Legal Business Name): JOSHUA WALTERS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-2102
US

IV. Provider business mailing address

9040 JACKSON AVE
TACOMA WA
98431-2102
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-6514
  • Fax:
Mailing address:
  • Phone: 253-968-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL-9338
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: