Provider Demographics
NPI:1467054171
Name:CARSON-WALKER, JULIE KRISTEN (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KRISTEN
Last Name:CARSON-WALKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:124 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3013
Mailing Address - Country:US
Mailing Address - Phone:512-925-6440
Mailing Address - Fax:
Practice Address - Street 1:124 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3013
Practice Address - Country:US
Practice Address - Phone:512-925-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2023794225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant