Provider Demographics
NPI:1437922267
Name:WALKER, NICOLE A
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SCOTT DR APT F
Mailing Address - Street 2:
Mailing Address - City:DRAVOSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15034-1148
Mailing Address - Country:US
Mailing Address - Phone:412-915-5167
Mailing Address - Fax:
Practice Address - Street 1:155 WATERDAM RD STE 100
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2606
Practice Address - Country:US
Practice Address - Phone:724-941-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE013509225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant