Michael Anthony Walters Jr., ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

LAT-4187 Issued in NC

Practice address

170 Kimel Park Dr
Winston Salem, NC 27103-6946

Phone

(336) 765-7058

NPI assigned

Aug 28, 2020

Last updated

Aug 28, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1699388868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 FALLBROOK LN",
            "city": "LEWISVILLE",
            "state": "NC",
            "postal_code": "270238628",
            "telephone_number": "336-624-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 KIMEL PARK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-765-7058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "LAT-4187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Marie Walter, OT
• James M Walter Jr., DDS MS
• Keith Andrew Walter, MD
• Alicia Catherine Walters Stewart, MD
• Jhunnelle Walters, MD
• William Christian Walton, CRNA
• Zachary Carl Walton, MD
• Joshua D Waltonen, MD
• Bailey Waltz, PT, DPT
• James J Waltz

• Athletic Trainer in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Athletic Trainer in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.