Provider Demographics
NPI:1619034717
Name:WALKER, LAURA (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-0436
Mailing Address - Country:US
Mailing Address - Phone:850-624-3125
Mailing Address - Fax:
Practice Address - Street 1:8 GEORGETOWN AVE
Practice Address - Street 2:
Practice Address - City:ROSEMARY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32461
Practice Address - Country:US
Practice Address - Phone:850-624-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA21175225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7989OtherBLUE CROSS PROVIDER