Provider Demographics
NPI:1780700864
Name:NEUBERGER, WALTER BERNARD (MSPT, DPT, STC)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:BERNARD
Last Name:NEUBERGER
Suffix:
Gender:M
Credentials:MSPT, DPT, STC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BEACH ST
Mailing Address - Street 2:BUILDING D
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2717
Mailing Address - Country:US
Mailing Address - Phone:401-348-8112
Mailing Address - Fax:401-348-7009
Practice Address - Street 1:85 BEACH ST
Practice Address - Street 2:BUILDING D
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2717
Practice Address - Country:US
Practice Address - Phone:401-348-8112
Practice Address - Fax:401-348-7009
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014120225100000X
RIPT02597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist