Provider Demographics
NPI:1790374346
Name:WALKER, BREANNA JORDANN (LPTA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:JORDANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 AZALEA RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-2859
Mailing Address - Country:US
Mailing Address - Phone:251-607-6495
Mailing Address - Fax:888-539-6550
Practice Address - Street 1:1220 AZALEA RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-2859
Practice Address - Country:US
Practice Address - Phone:251-607-6495
Practice Address - Fax:888-539-6550
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA9958225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant