Provider Demographics
NPI:1255460192
Name:WALKER, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CARRIAGE HOUSE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:614 CARRIAGE HOUSE DR
Practice Address - Street 2:SUITE E
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4238
Practice Address - Country:US
Practice Address - Phone:731-668-4449
Practice Address - Fax:731-668-4405
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000007300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist