Provider Demographics
NPI:1902408644
Name:WALKER, CARSON EDWARD (NASM-CPT)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:EDWARD
Last Name:WALKER
Suffix:
Gender:M
Credentials:NASM-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 WEILACHER RD SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9185
Mailing Address - Country:US
Mailing Address - Phone:330-979-8307
Mailing Address - Fax:
Practice Address - Street 1:3150 WEILACHER RD SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-9185
Practice Address - Country:US
Practice Address - Phone:330-979-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer