Provider Demographics
NPI:1285207019
Name:WALKER, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:BERNIE
Mailing Address - State:MO
Mailing Address - Zip Code:63822-0725
Mailing Address - Country:US
Mailing Address - Phone:810-610-7315
Mailing Address - Fax:
Practice Address - Street 1:117 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:BERNIE
Practice Address - State:MO
Practice Address - Zip Code:63822-8501
Practice Address - Country:US
Practice Address - Phone:810-610-7315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002757225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant