1225160161 NPI number — VICKI LYNN WALTERS P.T.

Table of content: VICKI LYNN WALTERS P.T. (NPI 1225160161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225160161 NPI number — VICKI LYNN WALTERS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTERS
Provider First Name:
VICKI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225160161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 503
Provider Second Line Business Mailing Address:
108 SWEDESBORO ROAD, SUITE 10
Provider Business Mailing Address City Name:
MULLICA HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08062-0503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-223-8898
Provider Business Mailing Address Fax Number:
856-223-8799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 SWEDESBORO RD STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MULLICA HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08062-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-223-8898
Provider Business Practice Location Address Fax Number:
856-223-8799
Provider Enumeration Date:
03/09/2007

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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