Provider Demographics
NPI:1699469601
Name:WALDEN, SKYLAR R (DPT)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:R
Last Name:WALDEN
Suffix:
Gender:F
Credentials:DPT
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 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-491-1390
Mailing Address - Fax:
Practice Address - Street 1:418 W 3RD ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-0704
Practice Address - Country:US
Practice Address - Phone:270-926-8145
Practice Address - Fax:270-926-8147
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist