Provider Demographics
NPI:1871923821
Name:WALK, BRENDA (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WALK
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 NORTHLAND DR STE 509
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-5039
Mailing Address - Country:US
Mailing Address - Phone:512-383-5706
Mailing Address - Fax:512-383-5707
Practice Address - Street 1:3305 NORTHLAND DR STE 509
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-5039
Practice Address - Country:US
Practice Address - Phone:512-383-5706
Practice Address - Fax:512-383-5707
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist