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General NPI Number Information
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NPI Number | 1962799049
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Entity Type | Individual
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Provider Name | LAURA BETH WALTERS DPT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 4565 DAISY REID AVE STE 215
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5670
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Country | US
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Telephone | 703-523-8752
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Fax |
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Provider Business Mailing Address
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Address Line | 3717 5TH AVE
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City | ALTOONA
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State | PA
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Zip | 16602-1706
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Country | US
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Telephone | 814-944-8678
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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 | PT 36829
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305207662
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License Number State | VA
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