Healthcare Provider Details

I. General information

NPI: 1396765574
Provider Name (Legal Business Name): DALE EDWARD WALKER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 SOUTH 4TH
LEAVENWORTH KS
66048
US

IV. Provider business mailing address

4104 SOUTH 4TH
LEAVENWORTH KS
66048
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax:
Mailing address:
  • Phone: 913-845-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-00350
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: