Healthcare Provider Details

I. General information

NPI: 1972328904
Provider Name (Legal Business Name): JOHN WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 GREEN FOREST LN STE 101
LUTZ FL
33558-5387
US

IV. Provider business mailing address

22327 RED JACKET LN
LAND O LAKES FL
34639-3979
US

V. Phone/Fax

Practice location:
  • Phone: 813-291-0037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: