Provider Demographics
NPI:1821325754
Name:WALKER, ELISABETH E (LMT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:E
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ERIE BLVD W
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2904
Mailing Address - Country:US
Mailing Address - Phone:315-339-3124
Mailing Address - Fax:315-339-3122
Practice Address - Street 1:900 ERIE BLVD W
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2904
Practice Address - Country:US
Practice Address - Phone:315-339-3124
Practice Address - Fax:315-339-3122
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist