Provider Demographics
NPI:1023162435
Name:WALKER, SUZANNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 RAINWOOD COVE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3942
Mailing Address - Country:US
Mailing Address - Phone:501-224-4070
Mailing Address - Fax:
Practice Address - Street 1:5623 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-7251
Practice Address - Country:US
Practice Address - Phone:501-794-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA837225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant