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General NPI Number Information
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NPI Number | 1063451342
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Entity Type | Individual
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Provider Name | VICKIE LEONA WALTERS LPTA
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 433 BROAD ST
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City | COLUMBIA
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State | MS
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Zip | 39429-3038
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Country | US
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Telephone | 601-444-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 1485 BROWNS BRIDGE RD
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City | HATTIESBURG
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State | MS
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Zip | 39401-8739
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Country | US
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Telephone | 601-434-9361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA3440
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License Number State | MS
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