Provider Demographics
NPI:1124844873
Name:WALKER, AMANDA (PT,DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:VIDEMSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:677 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2036
Mailing Address - Country:US
Mailing Address - Phone:440-665-2430
Mailing Address - Fax:
Practice Address - Street 1:677 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2036
Practice Address - Country:US
Practice Address - Phone:440-665-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist