Provider Demographics
NPI:1699183947
Name:WALKER, JACKSON RYAN (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:JACKSON
Middle Name:RYAN
Last Name:WALKER
Suffix:
Gender:M
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 1:530 SHADOWS LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6530
Mailing Address - Country:US
Mailing Address - Phone:225-927-9185
Mailing Address - Fax:225-231-3833
Practice Address - Street 1:530 SHADOWS LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-927-9185
Practice Address - Fax:225-231-3833
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist