Provider Demographics
NPI:1114902699
Name:WALKER, TODD CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:CHRISTOPHER
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 1:1895 MOWRY AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1766
Mailing Address - Country:US
Mailing Address - Phone:510-790-3213
Mailing Address - Fax:510-790-3337
Practice Address - Street 1:704 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4115
Practice Address - Country:US
Practice Address - Phone:510-790-3213
Practice Address - Fax:510-790-3337
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT244890Medicare PIN