Individual
MR. MICHAEL ANTHONY WALTERS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
170 KIMEL PARK DR, WINSTON SALEM, NC 27103-6946
(336) 765-7058
Mailing address
1055 FALLBROOK LN, LEWISVILLE, NC 27023-8628
(336) 624-4368
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
LAT-4187
NC
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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