Basic Information
Provider Information | |||||||||
NPI: | 1356779268 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WALKER | ||||||||
FirstName: | PATRICK | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | P.T., C.S.C.S | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 790 E MARKET ST STE 290 | ||||||||
Address2: |   | ||||||||
City: | WEST CHESTER | ||||||||
State: | PA | ||||||||
PostalCode: | 193824891 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6106963305 | ||||||||
FaxNumber: | 6106963306 | ||||||||
Practice Location | |||||||||
Address1: | 790 E MARKET ST STE 290 | ||||||||
Address2: |   | ||||||||
City: | WEST CHESTER | ||||||||
State: | PA | ||||||||
PostalCode: | 193824891 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6106963305 | ||||||||
FaxNumber: | 6106963306 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/31/2013 | ||||||||
LastUpdateDate: | 07/24/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT016048 | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 103007320 | 05 | PA |   | MEDICAID | 3015873 | 01 | DE | HIGHMARK | OTHER | 50132206 | 01 | PA | CAPITAL BC | OTHER | 3015873 | 01 | PA | HIGHMARK | OTHER | 1356779268 | 05 | DE |   | MEDICAID | 3915382000 | 01 | PA | IBC | OTHER | 3930195000 | 01 | DE | AMERIHEALTH (IBC) | OTHER | AC44-0062 | 01 | DE | CAREFIRST | OTHER |