Healthcare Provider Details

I. General information

NPI: 1821336124
Provider Name (Legal Business Name): JENNIFER LINDSAY WALKER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 MOUNTAIN VIEW RD SUITE 115
OOLTEWAH TN
37363-6668
US

IV. Provider business mailing address

10209 NISSI WAY
SODDY DAISY TN
37379-5457
US

V. Phone/Fax

Practice location:
  • Phone: 423-238-1277
  • Fax: 423-238-1277
Mailing address:
  • Phone: 423-316-7689
  • Fax: 423-238-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA0000004940
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPTA0000004940
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: