Individual
DAVE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3144 JOHN R RD, SUITE 200, TROY, MI 48083-5930
(248) 743-0850
(248) 743-0851
Mailing address
13464 CULVER DR, SHELBY TOWNSHIP, MI 48315-5371
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501006205
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E01877
BCBSM
MI
Enumeration date
07/26/2006
Last updated
02/05/2008
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