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  6. NPI Record 1336687433

ELIJAH WALKER PT, DPT
Complete NPI Record 1336687433
in Grand Rapids, MI

NPI Status: Active since February 08, 2017

Contact Information

235 WEALTHY ST SE
GRAND RAPIDS, MI
ZIP 49503
Phone: (616) 840-8000

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Credential Text
  6. Provider First Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Provider Gender Code
  20. Healthcare Provider Taxonomy Code 1
  21. Healthcare Provider Primary Taxonomy Switch 1
  22. Other Provider Identifier 1
  23. Other Provider Identifier Type Code 1
  24. Other Provider Identifier State 1
  25. Other Provider Identifier Issuer 1
  26. Is Sole Proprietor
  27. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1336687433. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1336687433
The city name in the mailing address of the provider being identified.
Entity Type Code: 1
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider First Name: ELIJAH
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Credential Text: PT, DPT
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Mailing Address: 235 WEALTHY ST SE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address City Name: GRAND RAPIDS
The city name in the location address of the provider being identified.
Provider Business Mailing Address State Name: MI
The State code in the location of the provider being identified.
Provider Business Mailing Address Postal Code: 495035247
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Practice Location Address: 235 WEALTHY ST SE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: GRAND RAPIDS
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MI
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 495035247
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6168408000
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 2/8/2017
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 1/4/2023
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 225400000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Other Provider Identifier 1: 5501302045
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: MI
Other Provider Identifier Issuer 1: MICHIGAN LICENSE
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 1/4/2023