Provider Demographics
NPI:1114609278
Name:WALKER, JONATHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 S 1000 E
Mailing Address - Street 2:
Mailing Address - City:CANNELBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47519-5035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1289 S 1000 E
Practice Address - Street 2:
Practice Address - City:CANNELBURG
Practice Address - State:IN
Practice Address - Zip Code:47519-5035
Practice Address - Country:US
Practice Address - Phone:812-787-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015231A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist