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NPI Code Detail

MEDICARE: DR. JACOB RYAN WALKER PT, DPT

MEDICARE: DR. JACOB RYAN WALKER PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305213694VA
2225100000XPhysical Therapist299190CA

General Provider Information

NPI Number : 1699382515
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB RYAN WALKER PT, DPT
Provider Business Mailing Address
First Line : 10117 STAGS LEAP DR
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23116-6221
Country : US
Telephone Number : 804-971-2041
Fax Number :
Provider Business Practice Location Address
First Line : 7060 N DURANGO DR STE 130
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4605
Country : US
Telephone Number : 702-826-5749
Fax Number : 702-273-3015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2020
Last Update Date : 12/08/2022

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