Healthcare Provider Details

I. General information

NPI: 1598171621
Provider Name (Legal Business Name): JAYCIE WALKER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N DIERS AVE SUITE 300
GRAND ISLAND NE
68803-4984
US

IV. Provider business mailing address

4725 MERLE HAY RD
DES MOINES IA
50322-1983
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax: 308-382-3241
Mailing address:
  • Phone: 515-254-1726
  • Fax: 515-331-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3339
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number077496
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: