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General NPI Number Information
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NPI Number | 1992953046
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Entity Type | Organization
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Legal Business Name | WATER WALKERS, LLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 3200 W CENTRE AVE STE 201
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City | PORTAGE
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State | MI
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Zip | 49024-4889
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Country | US
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Telephone | 269-365-3677
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Fax | 866-431-9323
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Provider Business Mailing Address
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Address Line | 3200 W CENTRE AVE STE 201
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City | PORTAGE
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State | MI
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Zip | 49024-4889
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Country | US
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Telephone | 269-365-3677
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Fax | 866-431-9323
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY ELDON MOFFIT
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Credential |
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Telephone | 269-207-6691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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