Individual
BRIDGET ELIZABETH WALTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
885 COUNTY ROUTE 57, PHOENIX, NY 13135-2197
(315) 420-1634
Mailing address
885 COUNTY ROUTE 57, PHOENIX, NY 13135-2197
(315) 420-1634
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
27 028627
NY
Other
Enumeration date
03/15/2015
Last updated
03/15/2015
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