Provider Demographics
NPI:1134436793
Name:WALKER, JEANNA MARIE (PT)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:MARIE
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 1:2236 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5799
Mailing Address - Country:US
Mailing Address - Phone:651-659-0208
Mailing Address - Fax:651-659-0161
Practice Address - Street 1:2236 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5799
Practice Address - Country:US
Practice Address - Phone:651-659-0208
Practice Address - Fax:651-659-0161
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN868K1CAOtherBCBS