Provider Demographics
NPI:1356779268
Name:WALKER, PATRICK (PT, CSCS)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:2714 PHILADELPHIA PIKE # A
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2568
Practice Address - Country:US
Practice Address - Phone:302-408-7310
Practice Address - Fax:302-416-4817
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016048225100000X
DEJ1-0001811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1356779268Medicaid
DE3015873OtherHIGHMARK
PA3915382000OtherIBC
PA50132206OtherCAPITAL BC
PA3015873OtherHIGHMARK
DEAC44-0062OtherCAREFIRST
DE3930195000OtherAMERIHEALTH (IBC)
PA103007320Medicaid
DE3930195000OtherAMERIHEALTH (IBC)
PA333677YENFMedicare PIN
DEAC44-0062OtherCAREFIRST