Healthcare Provider Details

I. General information

NPI: 1346558129
Provider Name (Legal Business Name): BRENDA WALKER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 1ST AVE 9F
NEW YORK NY
10009-2619
US

IV. Provider business mailing address

270 1ST AVE 9F
NEW YORK NY
10009-2619
US

V. Phone/Fax

Practice location:
  • Phone: 917-922-5087
  • Fax:
Mailing address:
  • Phone: 917-922-5087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPHY003061-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: