Provider Demographics
NPI:1316556087
Name:WALKER, KATIE JACKSON (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JACKSON
Last Name:WALKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18068 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-9600
Mailing Address - Country:US
Mailing Address - Phone:601-506-5704
Mailing Address - Fax:
Practice Address - Street 1:27190 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2224
Practice Address - Country:US
Practice Address - Phone:601-574-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist