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Larry R Walton
Specialist in Portage, Michigan
NPI 1063440311

Larry R Walton is a Specialist based in Portage, MI. Larry R Walton practices in Portage, MI. The NPI Number for Larry R Walton is 1063440311 and holds a License No. 039773 (Michigan).

The current practice location address for Larry R Walton is 1220 West Milham Ave, Portage, MI and can be reached out via phone at 269-382-9900 and via fax at 269-382-0700.

Location: 1220 West Milham Ave, Portage, MI, 49024-1206
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1063440311
Provider Name
Larry R Walton
Credential
Provider Entity Type
Individual
Gender
Male
Address
1220 West Milham Ave, Portage, MI, 49024-1206
Phone Number
269-382-9900
Fax Number
269-382-0700
Provider Enumeration Date
06/28/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
039279 01 MI BCBS PROVIDER ID
4079644 05 MI
institution
Provider Business Practice Location Address Details
Address
1220 West Milham Ave
City
Portage
State
Michigan
Zip
49024-1206
Phone Number
269-382-9900
Fax Number
269-382-0700
person
Provider Business Mailing Address Details
Address
1220 West Milham Ave
City
Portage
State
Michigan
Zip
49024-1206
Phone Number
269-382-9900
Fax Number
269-382-0700
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
039773 (Michigan)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
039773 (Michigan)
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
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