Provider Demographics
NPI:1366226938
Name:WALKER, DARA LESHAE (PTA)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:LESHAE
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 1:10316 BEARWALLOW CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5259
Mailing Address - Country:US
Mailing Address - Phone:910-728-5037
Mailing Address - Fax:
Practice Address - Street 1:320 JAKE ALEXANDER BLVD W
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1442
Practice Address - Country:US
Practice Address - Phone:704-636-0052
Practice Address - Fax:704-636-0044
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8212225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant