Healthcare Provider Details

I. General information

NPI: 1881681898
Provider Name (Legal Business Name): JOHN H WALKER JR. R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 HIGHWAY 82 W
GREENWOOD MS
38930-5069
US

IV. Provider business mailing address

702 HIGHWAY 82 W STE B
GREENWOOD MS
38930-5069
US

V. Phone/Fax

Practice location:
  • Phone: 662-455-5010
  • Fax: 662-455-5468
Mailing address:
  • Phone: 662-455-5010
  • Fax: 662-455-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0163
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: