Provider Demographics
NPI:1053623629
Name:WALTON, HEATHER DALE (DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DALE
Last Name:WALTON
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:DALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT, OCS
Mailing Address - Street 1:285 HYDRAULIC RIDGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8126
Mailing Address - Country:US
Mailing Address - Phone:434-817-0980
Mailing Address - Fax:434-817-0985
Practice Address - Street 1:285 HYDRAULIC RIDGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8126
Practice Address - Country:US
Practice Address - Phone:434-817-0980
Practice Address - Fax:434-817-0985
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist