Provider Demographics
NPI:1699382515
Name:WALKER, JACOB RYAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JACOB
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 1:10117 STAGS LEAP DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-6221
Mailing Address - Country:US
Mailing Address - Phone:804-971-2041
Mailing Address - Fax:
Practice Address - Street 1:7060 N DURANGO DR STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4605
Practice Address - Country:US
Practice Address - Phone:702-826-5749
Practice Address - Fax:702-273-3015
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213694225100000X
CA299190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist