MEDICARE: MRS. KELLY ELIZABETH WALKER LMT

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
1	172M00000X	Mechanotherapist	MA13331	FL

General Provider Information

NPI Number	:	1538594791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY ELIZABETH WALKER LMT

Provider Business Mailing Address
First Line	:	406 65TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-9142
Country	:	US
Telephone Number	:	772-633-6092
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 ROYAL PALM PT
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5217
Country	:	US
Telephone Number	:	772-492-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	09/06/2013

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