MEDICARE: MARIAH DEIRDRE WALKER PTA

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	225200000X	Physical Therapy Assistant	PTA29811	FL

General Provider Information

NPI Number	:	1861039562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH DEIRDRE WALKER PTA

Provider Business Mailing Address
First Line	:	1745 HORTON DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2756
Country	:	US
Telephone Number	:	720-397-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 ARLINGTON CIR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34113-3205
Country	:	US
Telephone Number	:	239-307-3061
Fax Number	:	847-730-2908

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

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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