Provider Demographics
NPI:1760555312
Name:WALKER, CHARLES LESLIE (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LESLIE
Last Name:WALKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7001
Mailing Address - Country:US
Mailing Address - Phone:845-703-6999
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:2 VICTORY CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1745
Practice Address - Country:US
Practice Address - Phone:845-522-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400109521Medicare PIN
NY10034454OtherCDPHP
NYQ08K31OtherBLUE CROSS BLUE SHIELD
NYQ28671Medicare ID - Type Unspecified
NY1193077OtherAETNA HMO
NY43898OtherMVP
NY6604410OtherGHI PPO
NY5299092OtherAETNA NON HMO
NY53845OtherGHI HMO