Provider Demographics
NPI:1104063494
Name:WALKER, DEBRA J (LMT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1408 CRESTONE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7325
Mailing Address - Country:US
Mailing Address - Phone:719-205-5114
Mailing Address - Fax:719-475-1880
Practice Address - Street 1:635 SOUTHPOINTE CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3877
Practice Address - Country:US
Practice Address - Phone:719-205-5114
Practice Address - Fax:719-475-1880
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO713083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist