Healthcare Provider Details

I. General information

NPI: 1164858338
Provider Name (Legal Business Name): JUSTIN WALKER BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CENTURY DR
MECHANICSBURG PA
17055-4374
US

IV. Provider business mailing address

1922 CHATHAM DR
CAMP HILL PA
17011-5916
US

V. Phone/Fax

Practice location:
  • Phone: 717-795-0330
  • Fax:
Mailing address:
  • Phone: 717-891-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: