Healthcare Provider Details

I. General information

NPI: 1235333782
Provider Name (Legal Business Name): SHANNON LYNN WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E LINCOLN AVE STE 111
ANAHEIM CA
92805-3203
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 1600
DOWNERS GROVE IL
60515-1211
US

V. Phone/Fax

Practice location:
  • Phone: 714-774-6502
  • Fax: 714-774-0860
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: