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General NPI Number Information
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NPI Number | 1932619921
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Entity Type | Individual
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Provider Name | AUTUMN R WALKINHOOD PTA
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Gender | Female
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 1251 WHITE MOUNTAIN HWY
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City | NORTH CONWAY
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State | NH
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Zip | 03860-5154
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Country | US
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Telephone | 855-511-6781
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PENZANCE AVE APT 81
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City | CHICO
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State | CA
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Zip | 95973-8259
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Country | US
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Telephone |
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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 |
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License Number State |
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