Individual
JUSTIN WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
858 NORTHERN PKWY, CINCINNATI, OH 45224-1759
(513) 516-5853
Mailing address
858 NORTHERN PKWY, CINCINNATI, OH 45224-1759
(513) 516-5853
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
830861600
830861600
OH
Enumeration date
07/22/2020
Last updated
07/22/2020
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