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NPI Code Detail

MEDICARE: PHYLLIS D WALKER P.T.

MEDICARE: PHYLLIS D WALKER P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist0075661NY
2225100000XPhysical Therapist11392SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00471498OTHERNYRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
211226693OTHERNYCAQH

General Provider Information

NPI Number : 1295865509
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS D WALKER P.T.
Provider Business Mailing Address
First Line : 137 FRONT ST
Second Line :
City : DEPOSIT
State : NY
Zip : 13754-1128
Country : US
Telephone Number : 607-467-5858
Fax Number : 607-467-5655
Provider Business Practice Location Address
First Line : 1621 HIGHWAY 17 N
Second Line :
City : NORTH MYRTLE BEACH
State : SC
Zip : 29582-2229
Country : US
Telephone Number : 843-353-3460
Fax Number : 843-353-3461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 08/15/2022

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Directions to “ PHYLLIS D WALKER P.T.” Practice Location

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