=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730122185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA BRINK WALKER PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 60TH STREET CT W SUITE C
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34209-5509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-792-0511
-----------------------------------------------------
Fax | 941-792-0560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1144 TALLEVAST RD SUITE 105
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34243-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-355-9601
-----------------------------------------------------
Fax | 941-355-9608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT21850
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------