Provider Demographics
NPI:1821229816
Name:WALKER, SANDRA MAE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MAE
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:PO BOX 4733
Mailing Address - Street 2:
Mailing Address - City:SOUTH COLBY
Mailing Address - State:WA
Mailing Address - Zip Code:98384-0733
Mailing Address - Country:US
Mailing Address - Phone:360-769-5944
Mailing Address - Fax:
Practice Address - Street 1:4459 SE MILE HILL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3908
Practice Address - Country:US
Practice Address - Phone:360-792-5994
Practice Address - Fax:360-769-5944
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty