Provider Demographics
NPI:1538594791
Name:WALKER, KELLY ELIZABETH (LMT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9142
Mailing Address - Country:US
Mailing Address - Phone:772-633-6092
Mailing Address - Fax:
Practice Address - Street 1:46 ROYAL PALM PT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5217
Practice Address - Country:US
Practice Address - Phone:772-492-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA13331172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist