Provider Demographics
NPI:1285912824
Name:WALKER, JUSTIN CHARLES (ATC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CHARLES
Last Name:WALKER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S LAFAYETTE ST APT 16
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:GARDNER WEBB UNIVERSITY ATHLETIC TRAINING
Practice Address - City:BOILING SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28017-9797
Practice Address - Country:US
Practice Address - Phone:704-406-4356
Practice Address - Fax:704-406-3503
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer