Provider Demographics
NPI:1992910038
Name:WALKER, AUDREY SORGEN (PHD, DPT)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:SORGEN
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHD, DPT
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:SORGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, DPT
Mailing Address - Street 1:1210 S OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1713
Mailing Address - Country:US
Mailing Address - Phone:303-378-4380
Mailing Address - Fax:
Practice Address - Street 1:1210 S OGDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1713
Practice Address - Country:US
Practice Address - Phone:303-378-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07357389Medicaid