Provider Demographics
NPI:1174780936
Name:WALKER, MARY P (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:WALKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 N WASHINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-393-2378
Mailing Address - Fax:931-455-9983
Practice Address - Street 1:1816 N WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-393-2378
Practice Address - Fax:931-455-9983
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511931Medicaid
TNP00819872OtherPALMETTO GBA-RAILROAD MEDICARE
TN4207028OtherBLUE CROSS BLUE SHIELD TENNESSEE
TN4207028OtherBLUE CROSS BLUE SHIELD TENNESSEE