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General NPI Number Information
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NPI Number | 1558510073
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Entity Type | Individual
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Provider Name | TERRI LYNN WALTERS
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Gender | Female
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 11080 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-1937
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Country | US
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Telephone | 310-966-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 S SHERBOURNE DR APT 5
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City | LOS ANGELES
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State | CA
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Zip | 90034-1353
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Country | US
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Telephone | 310-202-5415
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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