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General NPI Number Information
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NPI Number | 1629470828
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Entity Type | Individual
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Provider Name | MATTHEW MARCUS WALKO PT, DPT, CCS, CSCS
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Gender | Male
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 35 W MAIN ST
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City | ANNVILLE
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State | PA
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Zip | 17003-1319
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Country | US
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Telephone | 717-867-6854
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 BEACON CIR
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City | MECHANICSBURG
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State | PA
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Zip | 17055-6170
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Country | US
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Telephone | 717-579-8294
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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 | 2251C2600X
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Taxonomy Name | Cardiopulmonary Physical Therapist
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License Number | PT012868-L
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License Number State | PA
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