Provider Demographics
NPI:1699947309
Name:WALKER PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:WALKER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:801-787-0484
Mailing Address - Street 1:1644 E 900 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-9539
Mailing Address - Country:US
Mailing Address - Phone:801-787-0484
Mailing Address - Fax:
Practice Address - Street 1:655 EAST 400 SOUTH
Practice Address - Street 2:SUITE G
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663
Practice Address - Country:US
Practice Address - Phone:801-787-0484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114536-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528941664046Medicaid
UT528941664046Medicaid
UT0057466Medicare PIN