Thomas William Walters IV, PT, DPT, CSCS, PES

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01486400 Issued in NJ

Practice address

154 Kakeout Rd
Kinnelon, NJ 07405-2541

Phone

(973) 986-7987

NPI assigned

Mar 7, 2013

Sex

Male

Sole proprietor

Yes

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

Enrolled in NJ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Life Home Therapy LLC

  • Physical Therapist
  • Livingston, NJ
  • NPI 1467048777
  Medicare reassignment NPD
• The New Jersey Center of Physical Therapy, PC

  • Physical Therapist
  • Riverdale, NJ
  • NPI 1063508174
  NPD

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

{
    "created_epoch": "1362614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1932440450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 KAKEOUT RD",
            "city": "KINNELON",
            "state": "NJ",
            "postal_code": "074052541",
            "telephone_number": "973-986-7987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 KAKEOUT RD",
            "city": "KINNELON",
            "state": "NJ",
            "postal_code": "074052541",
            "telephone_number": "973-986-7987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "THOMAS",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "PT, DPT, CSCS, PES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-07",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01486400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Ann Vartelas, LCSW
• Viju Vijaysadan, M.D.
• Antonella F Viterbo, MS,PA-C
• Anne Hermanowski Vosatka, MD, PHD
• Walgreen Co (Walgreens #19207)
• Gail A. Wasserman, PH.D.
• Wayne Fleishhacker, DO, LLC
• Weill Cornell Medical Center
• Joann Castiglia Whitmore, LCSW
• Willing Hands, Inc.

• Physical Therapist in Kinnelon, NJ
• Providers in Kinnelon, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.