Basic Information
| Provider Information | |||||||||
| NPI: | 1871689448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AUSTRIA | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 247 | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474430247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126591440 | ||||||||
| FaxNumber: | 8126599995 | ||||||||
| Practice Location | |||||||||
| Address1: | LYONS HEALTH AND LIVING CENTER | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474430247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126591440 | ||||||||
| FaxNumber: | 8126599995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05008863A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.