Provider Demographics
NPI:1467761148
Name:WALKER, BRAD AFTON (BS, LPTA)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:AFTON
Last Name:WALKER
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Gender:M
Credentials:BS, LPTA
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Mailing Address - Street 1:13 EXECUTIVE DR
Mailing Address - Street 2:SUITE 18
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1342
Mailing Address - Country:US
Mailing Address - Phone:618-624-8105
Mailing Address - Fax:618-624-8214
Practice Address - Street 1:13 EXECUTIVE DR
Practice Address - Street 2:SUITE 18
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1342
Practice Address - Country:US
Practice Address - Phone:618-624-8105
Practice Address - Fax:618-624-8214
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
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Provider Licenses
StateLicense IDTaxonomies
IL160-002920225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant