Provider Demographics
NPI:1255603882
Name:WALKER, BRENDA JOY I (LPTA)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOY
Last Name:WALKER
Suffix:I
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18850 CARMANY DR
Mailing Address - Street 2:
Mailing Address - City:WALTON HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-4412
Mailing Address - Country:US
Mailing Address - Phone:216-224-3914
Mailing Address - Fax:
Practice Address - Street 1:18850 CARMANY DR
Practice Address - Street 2:
Practice Address - City:WALTON HILLS
Practice Address - State:OH
Practice Address - Zip Code:44146-4412
Practice Address - Country:US
Practice Address - Phone:216-224-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 1375225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant