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General NPI Number Information
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NPI Number | 1205676525
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Entity Type | Individual
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Provider Name | MIYAH TERES'E WALKER ATC
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Gender | Female
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 05/27/2024
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Provider Practice Location Address
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Address Line | 4400 FALCON PKWY
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-3176
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Country | US
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Telephone | 850-502-9139
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Fax |
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Provider Business Mailing Address
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Address Line | 3299 JULIET DR
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City | WOODBURY
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State | MN
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Zip | 55125-3819
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Country | US
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Telephone | 651-331-8838
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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