Healthcare Provider Details

I. General information

NPI: 1457066953
Provider Name (Legal Business Name): KENDYL J WALKER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13915 BURNET RD STE 204
AUSTIN TX
78728-6537
US

IV. Provider business mailing address

3206 BLUE RIDGE DR
CEDAR PARK TX
78613-5421
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 512-963-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2161071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: