Provider Demographics
NPI:1598171621
Name:WALKER, JAYCIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAYCIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 MERLE HAY RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1983
Mailing Address - Country:US
Mailing Address - Phone:515-254-1726
Mailing Address - Fax:515-331-8916
Practice Address - Street 1:620 N DIERS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4984
Practice Address - Country:US
Practice Address - Phone:308-382-0344
Practice Address - Fax:308-382-3241
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3339225100000X
IA077496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist