Provider Demographics
NPI:1760118269
Name:WALKER, JUSTIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
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 1:220 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-5029
Mailing Address - Country:US
Mailing Address - Phone:409-718-8050
Mailing Address - Fax:
Practice Address - Street 1:220 N 17TH ST
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-5029
Practice Address - Country:US
Practice Address - Phone:409-724-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1247386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist