Provider Demographics
NPI:1356878680
Name:WALTERS, TIMOTHY DANIEL II (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:WALTERS
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1975
Mailing Address - Country:US
Mailing Address - Phone:248-450-3159
Mailing Address - Fax:866-781-1879
Practice Address - Street 1:1700 THE GREENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2494
Practice Address - Country:US
Practice Address - Phone:248-450-3159
Practice Address - Fax:866-781-1879
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist