Provider Demographics
NPI:1346558129
Name:WALKER, BRENDA (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 1ST AVE
Mailing Address - Street 2:9F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2619
Mailing Address - Country:US
Mailing Address - Phone:917-922-5087
Mailing Address - Fax:
Practice Address - Street 1:270 1ST AVE
Practice Address - Street 2:9F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2619
Practice Address - Country:US
Practice Address - Phone:917-922-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPHY003061-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor