Healthcare Provider Details

I. General information

NPI: 1184695173
Provider Name (Legal Business Name): MICHAEL J. WALKER PT, DSC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

8434 DUSTY RDG
CONVERSE TX
78109-2311
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-1920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1028
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: