Provider Demographics
NPI:1033555255
Name:WALKER, NICHOLAS WAYNE (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:WAYNE
Last Name:WALKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 GRAVEL DR
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8496
Mailing Address - Country:US
Mailing Address - Phone:828-699-8766
Mailing Address - Fax:
Practice Address - Street 1:1460 JOHN B WHITE SR BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3996
Practice Address - Country:US
Practice Address - Phone:864-587-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist