Provider Demographics
NPI:1376856906
Name:WALKO, ANNETTE SUSAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:SUSAN
Last Name:WALKO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:ANNETTE
Other - Middle Name:DEMARK
Other - Last Name:WALKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4624 NW 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6080
Mailing Address - Country:US
Mailing Address - Phone:352-318-7946
Mailing Address - Fax:
Practice Address - Street 1:2929 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2831
Practice Address - Country:US
Practice Address - Phone:352-375-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 59282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist