Provider Demographics
NPI:1922201078
Name:WALKER, KIMBERLY MICHELE (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:WALKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3612
Mailing Address - Country:US
Mailing Address - Phone:626-354-0884
Mailing Address - Fax:
Practice Address - Street 1:4 DARTMOOR DR
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3612
Practice Address - Country:US
Practice Address - Phone:626-354-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031098-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist