Individual
JEFFREY WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
8700 W WATERTOWN PLANK RD, MILWAUKEE, WI 53226-3595
(414) 805-7111
Mailing address
1180 FAIRLANE AVE, BROOKFIELD, WI 53005-7004
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1048-39
WI
Other
Enumeration date
01/20/2015
Last updated
08/13/2020
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