Provider Demographics
NPI:1033508221
Name:WALKER, JEANI (ATC, MSED)
Entity Type:Individual
Prefix:
First Name:JEANI
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:ATC, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 S HIDDEN VALLEY DR UNIT 174
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6691
Mailing Address - Country:US
Mailing Address - Phone:307-399-4536
Mailing Address - Fax:
Practice Address - Street 1:3155 S HIDDEN VALLEY DR UNIT 174
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6691
Practice Address - Country:US
Practice Address - Phone:307-399-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8030326-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer