Provider Demographics
NPI:1073587622
Name:WALKER, STACY (PHD, ATC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEALTH PROFESSIONS BUILDING 439
Mailing Address - Street 2:BALL STATE UNIVERSITY
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47306-0001
Mailing Address - Country:US
Mailing Address - Phone:765-285-5175
Mailing Address - Fax:
Practice Address - Street 1:HEALTH PROFESSIONS BUILDING 439
Practice Address - Street 2:BALL STATE UNIVERSITY
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306
Practice Address - Country:US
Practice Address - Phone:765-285-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001094A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer