Healthcare Provider Details

I. General information

NPI: 1477513976
Provider Name (Legal Business Name): JANICE WALKER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N E ST
SAN BERNARDINO CA
92410-3012
US

IV. Provider business mailing address

40124 VILLAGE RD
TEMECULA CA
92591-3539
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-6333
  • Fax: 760-242-6339
Mailing address:
  • Phone: 678-923-3110
  • Fax: 951-296-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number32964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: