Provider Demographics
NPI:1235334319
Name:WALKER, JOHNNY L
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:L
Last Name:WALKER
Suffix:
Gender:M
Credentials:
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 6405
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-6405
Mailing Address - Country:US
Mailing Address - Phone:334-590-2889
Mailing Address - Fax:334-409-0110
Practice Address - Street 1:1431 MELISSA LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8937
Practice Address - Country:US
Practice Address - Phone:334-590-2889
Practice Address - Fax:334-409-0110
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist