Provider Demographics
NPI:1043337884
Name:WALTERS, FRANK E (PHD, ATC)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:E
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 NW 101ST TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1061
Mailing Address - Country:US
Mailing Address - Phone:954-831-2796
Mailing Address - Fax:954-831-2790
Practice Address - Street 1:300 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2550
Practice Address - Country:US
Practice Address - Phone:954-831-2796
Practice Address - Fax:954-831-2790
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 22292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer