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General NPI Number Information
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NPI Number | 1851277479
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Entity Type | Individual
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Provider Name | SAMUEL WALTERS PT
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Gender | Male
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 3101 BEAUMONT CENTRE CIR STE 120
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City | LEXINGTON
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State | KY
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Zip | 40513-2011
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Country | US
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Telephone | 859-639-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1129 DUNBARTON LN
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City | LEXINGTON
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State | KY
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Zip | 40502-3844
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Country | US
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Telephone | 859-338-2059
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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 | 009504
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License Number State | KY
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