1457430167 NPI number — MR. RAMSIN LEE WALTERS PHYSICAL THERAPIST

Table of content: MR. RAMSIN LEE WALTERS PHYSICAL THERAPIST (NPI 1457430167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457430167 NPI number — MR. RAMSIN LEE WALTERS PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTERS
Provider First Name:
RAMSIN
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BETYOUDOKOM
Provider Other First Name:
RAMSIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457430167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22311 VENTURA BLVD
Provider Second Line Business Mailing Address:
106
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91364-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-888-8300
Provider Business Mailing Address Fax Number:
818-888-8390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22311 VENTURA BLVD
Provider Second Line Business Practice Location Address:
106
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91364-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-888-8300
Provider Business Practice Location Address Fax Number:
818-888-8390
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT27248 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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