Provider Demographics
NPI:1740898790
Name:WALKER, SHANA RENEE (PT-ASSISTANT)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:RENEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PT-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 STAR HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2932
Mailing Address - Country:US
Mailing Address - Phone:361-793-9027
Mailing Address - Fax:
Practice Address - Street 1:7518 STAR HARBOR DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2932
Practice Address - Country:US
Practice Address - Phone:361-793-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2095633225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant