Provider Demographics
NPI:1154518645
Name:SOON- WALKER, TARAH DOREEN (PT)
Entity type:Individual
Prefix:MISS
First Name:TARAH
Middle Name:DOREEN
Last Name:SOON- WALKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:242 LINCOLN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-5378
Mailing Address - Country:US
Mailing Address - Phone:219-680-6844
Mailing Address - Fax:
Practice Address - Street 1:3467 PENINSULA DR APT 11
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4266
Practice Address - Country:US
Practice Address - Phone:219-880-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0500125A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist