Provider Demographics
NPI:1730122185
Name:WALKER, LAURA BRINK (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BRINK
Last Name:WALKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 TALLEVAST RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3267
Mailing Address - Country:US
Mailing Address - Phone:941-355-9601
Mailing Address - Fax:941-355-9608
Practice Address - Street 1:2301 60TH STREET CT W
Practice Address - Street 2:SUITE C
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5509
Practice Address - Country:US
Practice Address - Phone:941-792-0511
Practice Address - Fax:941-792-0560
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY085EOtherBCBS INDIV PROV NUM
FLY085EOtherBCBS INDIV PROV NUM
FLU5144ZMedicare ID - Type UnspecifiedMCR B INDIV PROV NUM