Healthcare Provider Details

I. General information

NPI: 1487882007
Provider Name (Legal Business Name): ALICIA WALKER DPT, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 NE 10TH ST
BELLEVUE WA
98004-8578
US

IV. Provider business mailing address

1 PETERS CANYON RD STE 120
IRVINE CA
92606-1748
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-3000
  • Fax: 844-620-1839
Mailing address:
  • Phone: 949-679-3988
  • Fax: 949-679-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00023020
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT293508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: