Provider Demographics
NPI:1932867363
Name:WALKER, COLTON DAVID (PT)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:DAVID
Last Name:WALKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 N MINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-1643
Mailing Address - Country:US
Mailing Address - Phone:308-520-9757
Mailing Address - Fax:
Practice Address - Street 1:244 N MINDEN AVE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1643
Practice Address - Country:US
Practice Address - Phone:308-832-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty