Basic Information
| Provider Information | |||||||||
| NPI: | 1740828185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 595 MARTHA JEFFERSON DR STE 180 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229114669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346545575 | ||||||||
| FaxNumber: | 4346548950 | ||||||||
| Practice Location | |||||||||
| Address1: | 595 MARTHA JEFFERSON DR STE 180 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229114669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346545575 | ||||||||
| FaxNumber: | 4346548950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2019 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 2000003238 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.