Healthcare Provider Details

I. General information

NPI: 1114616018
Provider Name (Legal Business Name): DIAMOND MONA WALKER PHYSICAL THERAPIST A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 N SERVICE ROAD SUITE 408
MELVILLE NY
11747
US

IV. Provider business mailing address

263 WARBURTON AVE FLOOR 2
YONKERS NY
10701
US

V. Phone/Fax

Practice location:
  • Phone: 631-223-4070
  • Fax:
Mailing address:
  • Phone: 917-741-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2306605146
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number029411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: