Provider Demographics
NPI:1124148754
Name:WALKER, WESLEY PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:PAUL
Last Name:WALKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 W EUGENE HILL WAY
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2290
Mailing Address - Country:US
Mailing Address - Phone:385-226-0368
Mailing Address - Fax:801-416-3446
Practice Address - Street 1:3086 W EUGENE HILL WAY
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2290
Practice Address - Country:US
Practice Address - Phone:385-226-0368
Practice Address - Fax:801-416-3446
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109490-24012251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT109490-2401OtherPROFESSIONAL LICENSE PT
UT109490-2401OtherPROFESSIONAL LICENSE PT