Basic Information
| Provider Information | |||||||||
| NPI: | 1427241348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MPT, CSCS, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 463 OHIO PIKE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452553721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172202100 | ||||||||
| FaxNumber: | 7172202131 | ||||||||
| Practice Location | |||||||||
| Address1: | 463 OHIO PIKE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452553721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172202100 | ||||||||
| FaxNumber: | 7172202131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 07/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | 01723 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
ID Information
| ID | Type | State | Issuer | Description | 490507 | 01 | OH | WELLCARE | OTHER | 000000590531 | 01 | OH | ANTHEM | OTHER | 2953960 | 05 | OH | MEDICAID |