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General NPI Number Information
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NPI Number | 1275825101
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Entity Type | Individual
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Provider Name | JULIAN RONN WALTERS DPT
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Gender | Male
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 7273 S SIWELL RD
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City | JACKSON
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State | MS
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Zip | 39272-9776
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Country | US
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Telephone | 601-372-8223
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Fax | 601-372-8125
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Provider Business Mailing Address
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Address Line | PO BOX 2153 DEPT 1947
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City | BIRMINGHAM
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State | AL
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Zip | 35287-0001
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Country | US
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Telephone | 601-944-1717
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Fax | 601-944-9780
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4854
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License Number State | MS
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