Provider Demographics
NPI:1770315459
Name:WALKER, BRANDON (PTA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:22 TOMPKINS ST
Mailing Address - Street 2:--
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1458
Mailing Address - Country:US
Mailing Address - Phone:203-419-0381
Mailing Address - Fax:203-419-0389
Practice Address - Street 1:690 MAIN ST SO
Practice Address - Street 2:SUITE 5
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2268
Practice Address - Country:US
Practice Address - Phone:203-267-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant