Provider Demographics
NPI:1740696905
Name:GREEN, WALKER (DPT)
Entity type:Individual
Prefix:
First Name:WALKER
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 RETAIL RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7808
Mailing Address - Country:US
Mailing Address - Phone:214-890-9853
Mailing Address - Fax:214-890-9856
Practice Address - Street 1:6243 RETAIL RD
Practice Address - Street 2:SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7808
Practice Address - Country:US
Practice Address - Phone:214-890-9853
Practice Address - Fax:214-890-9856
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1248451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist