Provider Demographics
NPI:1548834948
Name:SANDRIDGE-WALKER, DONNA (NBCMT, LMT, MMP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:SANDRIDGE-WALKER
Suffix:
Gender:F
Credentials:NBCMT, LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-0695
Mailing Address - Country:US
Mailing Address - Phone:434-328-6163
Mailing Address - Fax:434-296-5433
Practice Address - Street 1:4400 IVY CMNS
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-7123
Practice Address - Country:US
Practice Address - Phone:434-328-6163
Practice Address - Fax:434-373-8016
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017866225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist