Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 109490-2401 | UT |
NPI | 1124148754 |
---|---|
Provider Name | Mr. Wesley Paul Walker |
First Address | Taylorsville, UT 84129-2290 |
Second Address | Taylorsville, UT 84129-2290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 05/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
109490-2401 | PROFESSIONAL LICENSE PT (01) | UT |