Healthcare Provider Details

I. General information

NPI: 1811940521
Provider Name (Legal Business Name): TAMI SUE WALKER L-ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S MAIN ST
MCPHERSON KS
67460-5735
US

IV. Provider business mailing address

305 N OLIVETTE ST
MCPHERSON KS
67460-3730
US

V. Phone/Fax

Practice location:
  • Phone: 620-241-1825
  • Fax: 620-241-7135
Mailing address:
  • Phone: 620-654-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-01933
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00390
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: