Provider Demographics
NPI:1932619921
Name:WALKINHOOD, AUTUMN R (PTA)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:R
Last Name:WALKINHOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:R
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:100 PENZANCE AVE APT 81
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1251 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5154
Practice Address - Country:US
Practice Address - Phone:855-511-6781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant