Provider Demographics
NPI:1164756508
Name:WALK OF LIFE
Entity Type:Organization
Organization Name:WALK OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DME PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-505-0270
Mailing Address - Street 1:1027 HOLLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5534
Mailing Address - Country:US
Mailing Address - Phone:214-505-0270
Mailing Address - Fax:972-293-6333
Practice Address - Street 1:1027 HOLLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5534
Practice Address - Country:US
Practice Address - Phone:214-505-0270
Practice Address - Fax:972-293-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies