Provider Demographics
NPI:1497309249
Name:WALKER-WILSON, PAULA JEAN (LPT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:WALKER-WILSON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:217 E BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3435
Mailing Address - Country:US
Mailing Address - Phone:319-352-4544
Mailing Address - Fax:319-352-4655
Practice Address - Street 1:217 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3435
Practice Address - Country:US
Practice Address - Phone:319-352-4544
Practice Address - Fax:319-352-4655
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist