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General NPI Number Information
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NPI Number | 1114616018
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Entity Type | Individual
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Provider Name | DIAMOND MONA WALKER PHYSICAL THERAPIST A
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Gender | Female
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 395 N SERVICE ROAD SUITE 408
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City | MELVILLE
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State | NY
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Zip | 11747
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Country | US
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Telephone | 631-223-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 263 WARBURTON AVE FLOOR 2
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City | YONKERS
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State | NY
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Zip | 10701
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Country | US
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Telephone | 917-741-1140
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 029411
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2306605146
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License Number State | VA
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