Healthcare Provider Details

I. General information

NPI: 1134836380
Provider Name (Legal Business Name): WALKER JOE ANTHONY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 1675 RD
DELTA CO
81416-3462
US

IV. Provider business mailing address

697 1675 RD
DELTA CO
81416-3462
US

V. Phone/Fax

Practice location:
  • Phone: 970-985-1491
  • Fax:
Mailing address:
  • Phone: 970-985-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0024951
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: