Provider Demographics
NPI:1821336124
Name:WALKER, JENNIFER LINDSAY (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LINDSAY
Last Name:WALKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10209 NISSI WAY
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-5457
Mailing Address - Country:US
Mailing Address - Phone:423-316-7689
Mailing Address - Fax:423-238-1277
Practice Address - Street 1:6711 MOUNTAIN VIEW RD
Practice Address - Street 2:SUITE 115
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6668
Practice Address - Country:US
Practice Address - Phone:423-238-1277
Practice Address - Fax:423-238-1277
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000004940225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPTA0000004940OtherSTATE LICENSE