Individual
SAMUEL RICHARD WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1214 SWAN LAKE DR APT 302, CHARLOTTESVILLE, VA 22902-7266
(201) 991-0659
Mailing address
1214 SWAN LAKE DR APT 302, CHARLOTTESVILLE, VA 22902-7266
(201) 991-0659
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001872
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0126001872
VIRGINIA BOARD OF MEDICINE LICENSE
VA
01
—
70802201
ATHLETIC TRAINING BOARD OF CERTIFICATION
VA
Enumeration date
02/08/2017
Last updated
02/08/2017
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