Provider Demographics
NPI:1811082704
Name:WALKER, MICHAEL WAYNE (PT/ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:WALKER
Suffix:
Gender:M
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9131 TEJAS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8044
Mailing Address - Country:US
Mailing Address - Phone:904-733-0377
Mailing Address - Fax:
Practice Address - Street 1:4565 US HIGHWAY 17 STE 17
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4842
Practice Address - Country:US
Practice Address - Phone:904-634-0640
Practice Address - Fax:904-634-0203
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8915059 00Medicaid