Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 01723 | OH |
NPI | 1427241348 |
---|---|
Provider Name | John C Walker |
First Address | Cincinnati, OH 45255-3721 |
Second Address | Cincinnati, OH 45255-3721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 12/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000590531 | ANTHEM (01) | OH |
2953960 | (05) | OH |
490507 | WELLCARE (01) | OH |