Active NPI
Audie Riley Walters, PTA
- Physical Therapist
- Willimantic, CT
National Provider Identifier
1619821261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2454
- Practice address
- 595 Valley St
Willimantic, CT 06226-1901 - Phone
- (860) 450-7060
- NPI assigned
- Feb 23, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2454 | CT | Primary |
Addresses
Primary practice location
595 Valley St
Willimantic, CT 06226-1901
Mailing address
195 Fitchville Rd Apt 3
Bozrah, CT 06334-1125
Phone (860) 501-6325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1771804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771804800000",
"number": "1619821261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "195 FITCHVILLE RD APT 3",
"city": "BOZRAH",
"state": "CT",
"postal_code": "063341125",
"telephone_number": "860-501-6325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "595 VALLEY ST",
"city": "WILLIMANTIC",
"state": "CT",
"postal_code": "062261901",
"telephone_number": "860-450-7060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "AUDIE",
"middle_name": "RILEY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-02-23",
"last_updated": "2026-02-23",
"certification_date": "2026-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "2454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willimantic, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.