Provider Demographics
NPI:1568417632
Name:WALKER, WENDY RAE (PT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:RAE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:RAE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12320 SE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-5315
Mailing Address - Country:US
Mailing Address - Phone:425-228-5996
Mailing Address - Fax:425-271-2310
Practice Address - Street 1:981 POWELL AVE SW STE 130
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2990
Practice Address - Country:US
Practice Address - Phone:425-228-5996
Practice Address - Fax:425-271-2310
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0169622OtherDEPT OF LABOR & INDUSTRIE
WA4510166OtherAETNA/LEXINGTON, KY
WA5691WAOtherREGENCE BLUE SHIELD
WA810588134-10OtherKPS HEALTH PLANS
WAGAB36754Medicare PIN