Provider Demographics
NPI:1346631868
Name:WALKER, RICHARD ALLEN JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 S BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:S CHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368-9792
Mailing Address - Country:US
Mailing Address - Phone:937-462-8032
Mailing Address - Fax:
Practice Address - Street 1:3181 S BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:S CHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368-9792
Practice Address - Country:US
Practice Address - Phone:937-462-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-4612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer