Provider Demographics
NPI:1174630768
Name:PROKOP, WALTER J (KT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:J
Last Name:PROKOP
Suffix:
Gender:M
Credentials:KT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-0438
Mailing Address - Country:US
Mailing Address - Phone:708-202-3937
Mailing Address - Fax:
Practice Address - Street 1:EDWARD HINES VA HOSPITAL
Practice Address - Street 2:5000 1ST AVE
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist