Healthcare Provider Details

I. General information

NPI: 1427147974
Provider Name (Legal Business Name): GRACE L WALKER PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W TOWN AND COUNTRY RD STE 1
ORANGE CA
92868
US

IV. Provider business mailing address

26500 AGOURA RD STE 201
CALABASAS CA
91302-3556
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-5518
  • Fax: 714-744-2650
Mailing address:
  • Phone: 818-880-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8490
License Number StateCA

VIII. Authorized Official

Name: TIM MURPHY
Title or Position: VP OPERATIONS
Credential:
Phone: 818-880-8605