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General NPI Number Information
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NPI Number | 1295336360
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Entity Type | Individual
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Provider Name | KELLY LYNN WALTON PT
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Gender | Female
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 9400 N SHORE BLVD
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City | LAKESIDE MARBLEHEAD
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State | OH
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Zip | 43440-1337
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Country | US
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Telephone | 419-798-8203
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Fax |
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Provider Business Mailing Address
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Address Line | 87 N MARGARET DR
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City | LAKESIDE MARBLEHEAD
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State | OH
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Zip | 43440-2514
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Country | US
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Telephone | 419-217-5272
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | OH-10555
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License Number State | OH
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