Provider Demographics
NPI:1275510299
Name:WALKER, JERROD DOUGLAS (PT)
Entity Type:Individual
Prefix:MR
First Name:JERROD
Middle Name:DOUGLAS
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 1:2980 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8903
Mailing Address - Country:US
Mailing Address - Phone:205-384-1941
Mailing Address - Fax:
Practice Address - Street 1:2980 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8903
Practice Address - Country:US
Practice Address - Phone:205-384-1941
Practice Address - Fax:205-384-6362
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL96211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000001568Medicaid
AL051501568OtherBCBS OF ALABAMA
AL650020848OtherMEDICARE RAILROAD
AL650020848OtherMEDICARE RAILROAD
AL0879600001Medicare NSC
AL000001568Medicaid