Provider Demographics
NPI:1114978889
Name:WALKER, JONATHAN T (MSPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
Last Name:WALKER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 ATWOOD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3262
Mailing Address - Country:US
Mailing Address - Phone:401-351-0515
Mailing Address - Fax:401-351-0530
Practice Address - Street 1:1539 ATWOOD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3262
Practice Address - Country:US
Practice Address - Phone:401-351-0515
Practice Address - Fax:401-351-0530
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411351OtherBLUECHIP RI IND. ID #
RI007056040Medicare ID - Type UnspecifiedMEDICARE RI IND. ID#