Provider Demographics
NPI:1891029427
Name:WALKER, CRYSTAL L (PT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
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 1:40 HENRIETTA BLVD
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1111
Mailing Address - Country:US
Mailing Address - Phone:518-843-3003
Mailing Address - Fax:518-875-6389
Practice Address - Street 1:40 HENRIETTA BLVD
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1111
Practice Address - Country:US
Practice Address - Phone:518-843-3003
Practice Address - Fax:518-875-6389
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007180-1225200000X
NY032553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant